Medicare Advantage plans taking advantage of new policies that give them flexibility

Policies giving Medicare Advantage (MA) plans more flexibility has made it a "fertile testing ground" for examining strategies for improving the quality of care for patients with serious or advanced illnesses, according to a new paper from the Duke-Margolis Center for Health Policy.

The study, released Friday, examined whether a rule giving Medicare Advantage plans more flexibility would result in meaningful changes to services delivered to patients with serious and advanced illnesses. 

So far, the researchers said, it has.

Instead of providing intensive medical care to patients who are unlikely to recover, the new models focus on what Duke-Margolis calls “high-touch” services. These services range from nursing to nutrition, and they are often provided in a patient’s home or residential facility.

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But these models are new in MA. And whether the program will ultimately save money and improve patient satisfaction remains to be seen.

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“Serious illness patients across the board are an area where we don’t have a lot of evidence,” said Robert S. Saunders, Ph.D., another author of the report. “What is the most effective way to talk to this group of patients? Coordinate their care? Provide the non-medical services that they need?”

Plus, these models have been developed by third parties, rather than the Centers for Medicare and Medicaid Services (CMS), which could make evaluation challenging.

“There’s no incentive, necessarily, for a plan to evaluate how [their services] affect their patient population, and then share that more broadly – that’s some proprietary information that could help the plan out,” said Saunders. “In some ways, the onus is on the plans to develop that evidence.”