Medicare Advantage is gaining ground among patients and practices are well-advised to investigate those contracts, as we reported on October 16, . Donald Rebhun, M.D., a medical director wirth the DaVita Medical Group, co-chair of the Quality and Performance Committee for the California Association of Physician Groups (CAPG) and board member with the Integrated Healthcare Association (IHA), contributed to that story, and has these further thoughts:
Humble beginnings: “Medicare Advantage initially attracted people of lower socio-economic means,” says Rebhun. “It continues to be more attractive for patients concerned about the high cost of health care and those whose co-payments have had significant impact on their lives; however, more are now attracted based on the added services and benefits provided and the coordination of care associated with these plans.”
Where it’s booming: “Medicare Advantage is continuing to see increasing enrollment and popularity throughout the country,” says Rebhun; “however, that penetration varies widely between the states -- from 1% in Alaska to 56% in Minnesota.” Among the reasons: “Payment to physicians, health care professionals, hospitals and vendors varies between states.” Also, there are fewer clinicians in small and rural communities so Medicare Advantage is less likely to penetrate, while in certain states such as California “commercial HMOs have been extremely popular with employers,” making the resource-sharing model familiar and “acceptable and preferable to many.”
The risk adjustment factor. “Risk adjustment coding seems burdensome – almost like learning a new language, taking up a sport, or learning how to paint,” says Rebhun. “It takes time and can be frustrating... But risk adjustment is associated with your payments, which hopefully help patients" while "physicians get paid more for the anticipated extra time it will take with patients who have a higher-risk ‘burden’ of illness. Additionally, physicians are often paid in Medicare Advantage for achieving higher for patient satisfaction and quality metrics.”
Future growth: The numbers for Medicare Advantage plans “will continue to escalate as these plans contract with high performance networks as opposed to narrow networks” with which they have been associated in recent years, says Rebhun. Also, the increasing public availability of quality scores will make high-scoring Medicare Advantage plans more attractive.