Medicare Advantage may be best program to power healthcare reform

Though some have championed Meaningful Use (MU) as a key tool for driving reform in the healthcare system, its power pales in comparison to that of the increasingly popular Medicare Advantage (MA) program, argues an opinion piece from Healthcare IT News.

MU has led to the rise of hundreds of electronic health records (EHR) vendors and enjoys considerable funding via the HITECH Act, yet it "it fails to motivate both payers and consumers who both play a role in sustainable reform," writes Frank Ingari, president and CEO of healthcare communications network company NaviNet.

MA, on the other hand, engages multiple healthcare stakeholders to upend the traditional fee-for-service paradigm, Ingari writes. To be successful in the MA sphere, insurers must offer contacts with providers that reward them for managing patients' chronic conditions, share population health data and infrastructure with providers who might not be able to afford their own, and meet the federal government's Star Rating metrics that challenge them to continually increase clinical quality.

Further, while EHR vendors and hospital-based delivery systems have little to no reason to market directly to consumers, MA insurers have the budget and the motivation to do so, which in turn allows them to influence behavior and truly drive reform, according to the opinion piece.

Medicare Advantage is indeed having its moment in the sun, as contrary to predictions its enrollment has grown 42 percent since 2010 and is expected to reach 30 million by 2025, FierceHealthPayer has reported. One of the reasons for its popularity may be the "robust" plan choice MA enrollees enjoy, a trend that's expected to continue even as major insurers merge--in part to gain greater MA market share.

Some critics, though, are concerned insurers may inflate Hierarchical Condition Category codes, Ingari notes, though he says the Centers for Medicare & Medicaid has ample systems in place to prevent abuse. Still, a recent government audit revealed millions in MA overpayments.  

To learn more:
- read the opinion piece

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