The Daily Dose
Making the Case for Medicare Advantage
The American health care system is in a state of flux. From the skyrocketing cost of specialty pharmaceuticals to a recent surge in hospital consolidations, health care – as we know it – is undergoing a massive makeover, and no one knows if it will be prettier in the end. There is, however, one shining star in the bunch – the Medicare Advantage (MA) program, which is typically purchased by those 65 and older.
Unlike traditional Medicare, MA requires health plans and doctors to work collaboratively to take care of their members and incentivizes plans that manage and coordinate high-quality care at a lower cost. In fact, MA plans throughout the country are achieving substantial improvements in quality through value-added services like case management, medication therapy management, nutrition and wellness programs, and even no-cost gym memberships.
When Congress passed the Medicare Modernization Act (MMA) of 2004 and established Medicare Advantage, the program placed the onus of care management on the nation’s health plans. The idea was simple: Private plans will be incentivized to manage the care of the Medicare population better than the federal government. This concept has proven to be quite successful, as nearly one-third of those eligible for traditional Medicare instead opt for Medicare Advantage.
A series of recent studies demonstrates the ability of Medicare Advantage plans to improve care. In 2010, researchers affiliated with the Brookings Institution and Harvard University Economics Department found that MA plans outperformed the fee-for-service (FFS) program in nine out of 11 clinical quality measures. In February 2012, the American Journal of Managed Care published a study showing the hospital readmission rate for MA enrollees was about 13 to 20 percent lower than FFS beneficiaries.
Despite the insurmountable evidence in favor of Medicare Advantage, federal policy oftentimes works against the program. The Affordable Care Act imposed a series of taxes and restrictive reimbursement practices that fail to protect the program from rising health care costs. As a result, more and more plans have been forced to increase premiums and slash benefits, disproportionately impacting those who can least afford it – the more than 40 percent of Medicare Advantage enrollees who earn less than $20,000 per year.
With so many uncertainties in the health care industry, it’s time for decision-makers to wake up to the reality that Medicare Advantage is working and is sought after by a large percentage of the eligible population. CDPHP®, like many other health plans, works diligently to provide exceptional service and control costs for the 41,000 seniors currently enrolled in our Medicare products. Our plans are routinely rated among the best in the nation*. We will continue to work with policymakers on both sides of the aisle to strengthen this critically important program.
*NCQA’s Medicare Health Insurance Plan Ratings 2015-16
John D. Bennett, MD, FACC, FACP About the Author
John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.
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