Medicare Advantage plans could see pay boosts under new models
HHS SECRETARY ALEX AZAR last week hinted that Medicare Advantage plans could see pay boosts as part of the Trump administration’s strategy to tackle maternal mortality rates, social determinants of health and rural healthcare access.
“We can also enhance value through payments in Medicare Advantage, where we want to open up more opportunities for MA plans … including creative value-based insurance design arrangements, moving care to the home and community, and new ways for MA plans to improve a patients’ health over the long term,” Azar said at the Better Medicare Alliance’s policy summit.
Those innovative arrangements include the primary-care models that Azar and CMS Administrator Seema Verma announced earlier this year, which could be a boon to Medicare Advantage business.
In April, administration officials unveiled their plan to shift fee-for-service into a global pay structure where physicians, hospitals, clinics or Medicare Advantage plans would assume more risk.
But beyond this effort, Azar hinted that HHS will use its pay models to try to combat the spiking maternal mortality rates that the Trump administration and lawmakers on both sides of the aisle recognize as a crisis. Overhauling payments could also prop up rural healthcare, including access to specialists, he said.
“Rural access to care can be a huge challenge: There are 263 specialists for every 100,000 Americans in urban areas, compared with just 30 per 100,000 in rural areas,” Azar said. “But we believe we can design new ways to sustainably finance care in these areas, supporting innovation and providing flexibility to meet these communities’ health needs.”
Medicare Advantage could also play a role in the administration’s plan to address social determinants of health.
Azar remained vague about President Donald Trump’s recent executive order on price transparency for hospitals and insurance companies. The practical impact of that order is largely up to HHS’ interpretation, but Azar didn’t offer any details on when the regulations will be released or what they could look like. ●