Back in October, for pushback against Democratic presidential candidates’ healthcare-for-all campaign planks, the White House issued an executive order expanding “on Protecting and Improving Medicare for Our Nation’s Seniors” building on new CMS rules from 2018
... (revised for 2019&2020) that allowed [Medicare Advantage] plans to offer additional “primarily health-related” supplemental medical benefits that maintain or improve overall health. At about the same time, Congress adopted the CHRONIC Act, a law that allowed plans to offer non-medical services to members with chronic conditions. The new law also gave plans important flexibility that makes it possible for them to tailor benefits to people with specific needs. For instance, plans could offer nutrition coaching to members with diabetes without having to offer similar services to all its members… adult day programs ... caregiver supports ... non-medical supplemental benefits ... ranging from rides to the grocery store to pest control… — Forbes, Oct 7, 2019
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...dental, fitness, vision, and hearing benefits … transportation assistance … telemonitoring services…— KFF Oct 24, 2019
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...palliative care … non-opioid pain management … in-home support services … food, indoor air quality equipment … personal care services … a memory fitness benefit … home and bathroom safety devices and modifications [and others, primarily] for seriously ill [Medicare Advantage] enrollees … which the agency specified as diabetes, dementia, heart failure, and stroke .. [and for MA] members with chronic illnesses [to help] maintain their health and ability to live independently…
[But in 2019] 11% of the total number of plans [offered any, and fewer will] in 2020, [although] the reduction is based largely on the actions of one national payer, according to a new study from the Duke Margolis Center for Health Policy. — HealthcareDive.com Dec 11, 2019
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<big>The catch, as found in that study, is that these shiny new benefits tend to be little available in rural areas “or in areas with higher concentrations of Medicare-eligible seniors who are enrolled in MA plans” and they’re not available to anyone who only has traditional Medicare, because</big>
CMS did not provide new funding to pay for the supplemental benefits, making it challenging for the insurers to offer more than a few new benefits” [except with added premium payment from enrollees, as some MA plans have been doing already].
Another issue is the administrative complexity and cost involved in contracting with local organizations that provide social services such as adult daycare or in-home support services. These organizations may lack the technical sophistication to manage protected health information or carry liability insurance that meets insurers’ rules. As one interviewee told the researchers, “It’s a lot of work to teach organizations how to contract with a health plan.”
There’s also a lack of evidence about how enrollees will use the new benefits, [and whether] the benefits will lead to cost savings in future years, or attract different members, potentially altering a plan’s risk pool.
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Among the attractions for insurers are: ■ the possibility that meeting lesser needs earlier can support senior health enough to significantly decrease higher, prolonged costs of worsened health later. ■ expanded options will increase their competitive edge for senior customers with the income to afford their programs and good enough current health or familial support to winnow through plans available where they live — about 22 million, or 34% of Medicare beneficiaries as of 2019. That’s the sector whose 2020 votes the President is after.
But there’s another attraction for insurers, too.
[While the] MA program has been growing steadily ..., nearly doubling over the past decade to include 21 million Americans, or about a third of all Medicare enrollees.…
- Medicare Advantage health plans may be inflating capitated payments by as much as $6.7 billion a year, according to a [Dec.10, 2019 report by the HHS Office of Inspector General [OIG].
- The suspected inflation is primarily the result of tacking on new diagnosis codes as part of [review of existing medical charts not prompted by any face-to-face patient encounters CMS regulations require and which CMS has been lax to enforce], a practice intended to encourage payers to take on MA enrollees who may be particularly costly to care for.
- OIG recommended that CMS take steps to tighten the audit processes of such charts, among other changes to better monitor the practices of health plans.
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Briefly put, MedicareAdvantage plans are serving the most privileged demographic while ripping off Medicare to the detriment of ordinary beneficiaries, and supporting Republican campaign rhetoric in the process.
"These people are crazy," [the President said October 3, 2019 Healthcaredive of Democrats during the signing ceremony at ... a senior community.] "They want to take it away" … “As long as I'm president, no one will lay a hand on your Medicare benefits."
[He derided what’s commonly called] "Medicare for All," as socialized medicine that leads to rationing care, diminished quality and higher taxes.
The nation's insurance lobby applauded the directive, saying it would improve choices for seniors and those with disabilities.
"We support the executive order's direction [for] Medicare Advantage ..." Matt Eyles, CEO of America's Health Insurance Plans, said in a statement.
The executive order gives wide latitude to HHS Secretary Alex Azar to draft [regulations tackling] a range of topics from alternative payment models to reducing regulatory burdens.
For example ... the order allows changes to … "anticompetitive restrictions."
Additionally, the directive calls for relaxed regulations to allow providers more time with patients and [for] reimbursement to reflect the amount of time a provider spends with a patient.
The order also calls for the HHS secretary to provide Medicare claims data to health providers to spot practice patterns "that may pose undue risks to patients, and to inform health providers about practice patterns that are outliers or that are outside recommended standards of care."
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The irony is that objective research in large populational studies around the world demonstrates that most of the touted helps to patients really do perform for seniors and the disabled, and healthcare systems alike, including in the Us.
The tough part is that although these kinds of benefits would be more economical in the long run than not providing them, they don’t come cheap especially starting out, before longterm better health across the entire population would start to decrease costs.
Which they can’t do anyway in a larcenous system.
Nor, on a side note, if providing them is contingent upon first winning the battle to tax the rich. But that’s a whole nother ballgame.