CMS’s Verma: Medicare Advantage Works, Medicare for All Doesn’t

In a scathing speech criticizing over-involvement of government in health care, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma praised Medicare Advantage (MA) as a bright spot.

Specifically, she pointed to the competitive nature of the program as a driver of its success.

“Don’t get me wrong: There are a lot of successes in Medicare,” Verma said Monday during the MA Summit hosted by the Better Medicare Alliance in Washington, D.C. “What works in the Medicare program is Medicare Advantage because plans are competing on the basis of cost and quality, driving toward value and increasing choices for beneficiaries.”

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While Verma spent much of her keynote speech bashing Medicare for All and public-option health care proposals — calling them the “largest threats to the American healthcare system” — she touted the Trump administration’s expansion of the MA program.

For home-based care providers, that expansion has meant more power to address social determinants of health with services that have historically been deemed non-medical, such as home modification, companion care, carpet cleaning and more. 

In 2019, CMS allowed non-medical in-home care as a supplemental MA benefit for the first time ever. And in 2020, plans will have even more flexibility, as the agency has since OK’d all supplemental benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions.

Aside from home-based care providers, the expansions have also generated excitement among payers and patients.

Last year, 600 new Medicare Advantage plans entered the market, while enrollment increased 10% to an all-time high of nearly 23 million beneficiaries.

“We expect the upcoming year to be no different,” Verma said, teasing the introduction of a redesigned plan finder tool set to be unveiled later this year.

“It [will be] easier for beneficiaries to compare their plan options, which is especially important with all the new supplemental benefits that [MA plans] are going to offer,” she said. 

On top of that, the increased interest will mean more choices and lower costs, Verma told summit attendees. Already, MA premiums are at the lowest they’ve been in six years, down 6% on average since last year, she said.

In addition to Medicare Advantage, Verma also preached the importance of moving from volume-based to value-based reimbursement for health care providers, noting the current administration is “doing everything we can to accelerate” the process. 

Two recent examples include the Primary Cares Initiative — a voluntary risk-based initiative designed to reward doctors who keep patients at home and away from hospitals — and a series of pilot programs for kidney-related conditions, which could create incentives and opportunities for home-based kidney care.

“I would encourage all private plans, including Medicare Advantage to participate in these models,” Verma said.

Meanwhile, in the home health space, CMS has been testing out the Value-Based Purchasing Model in nine states. The agency floated the idea of making results in that demonstration public in its latest proposed payment rule, released July 11.

Industry insiders speculate the proposal could create the infrastructure needed to expand the nine-state demo elsewhere.

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