The following is all from George Halvorson at The Health Care Blog.
The capitation paid to Medicare Advantage (MA) plans for each member is based each year on the actual average cost of fee-for-service Medicare in every county. Payments to the plans are now running about 11% below that average cost.
Fee-for-service Medicare is expensive and too often is poorly delivered. The fee-based payment model pays more for bad and failed care because when the caregivers are paid only by the piece, they have more pieces to deliver when care fails. They deliver and bill for even more pieces when the health of a member deteriorates. When inferior care creates complications and mishaps, more pieces of care are needed for that patient.
Diabetic Blindness Reduced By 60% With Blood Sugar Control. The plans know that diabetic blindness can be reduced by 60% or more if the patients have their blood sugar controlled…. Large numbers of people do not go blind because 90% of MA plans now achieve the blood sugar improvement goals, and the money saved by people not going blind is now spent by the plans to provide free vision benefits to their members.
Heart Failure and Asthma. The plans identify which patients have congestive heart failure or asthma and then they work with those patients to significantly reduce their crisis levels and improve care for those patients. The MA members with those conditions have much better lives and they have less physical pain, stress, anxiety and damage because they avoid those crises. The better care results in 40% fewer days in the hospital for both of those conditions.
Amputation Five-Year Mortality Rate is Over 40%. A major expense for the Medicare program is amputations. We have some of the highest amputation rates in the world for our lower income patients. MA plans know that 90% of amputations are caused by foot ulcers. You can reduce foot ulcers by more than 60% just by having dry feet and clean socks. So, the plans save billions of dollars that create surpluses in their capitation cash flow and they significantly improve the life expectancy of those patients…. The five-year mortality rate for the people who have amputations ranges from 40%–80%. In their attacks on the program.
Special Needs Plans Now Serve Over 6 Million People. MA Special Needs Plans (SNP) just had their enrollment grow to 6.5 million members in January of this year. SNP enrollees are eligible for both Medicare coverage and Medicaid coverage. They have some of the highest health care needs in the country and too often have some of the lowest levels of resources to deal with basic aspects of their lives and their care. Millions of people enrolled in SMP plans have been badly impacted by various social determinants of health issues, as well as by care delivery failures for their entire lives. SNPs are often the first organized care related support that millions of those patients have had for their personal care.
People With Weak Retirement Plans Need the Additional Benefits. [A]lmost 90% of our lowest income Medicare beneficiaries are now enrolled in MA plans…. [T]hose numbers include more than 70% of African-Americans and more than 80% of Hispanics. Additionally, MA has language competency requirements for Hispanic enrollees that do not exist for fee-for-service Medicare. The most current data about retirement benefits tells us that more than half of Black and Latinx households have no retirement savings at all…. They are retired but have few assets and low levels of financial support for their retirement years.
If a low-income enrollee has mouth pain and needs dental work and support, FFS Medicare does nothing to help. If the pain for the patient is real and immediate, that steers them into MA plans with dental benefits and it makes those benefits important to the daily life of those members. That mouth pain is likely to be permanently relevant to that patient.
Medicare Advantage Is Creating a New Culture of Care for the Country. [T]he Medicare Advantage five-star quality program is having a very powerful impact on both the processes of care and the culture of care in America. It is game changing and directionally correct for the country. The Five Star Quality recognitions are becoming the new national standard of care.