Medicare Advantage Outperforms Original Medicare
The federal government is modernizing aging care under Medicare. The Medicare Advantage (MA) legislation of 2019 was a huge improvement focusing on the social determinants of health as legitimate medical needs. This change and others are spurring innovation to address health inequities and save money. The legislation states “the benefit must diagnose, prevent, or treat an illness or injury; compensate for physical impairments; act to ameliorate the functional or psychological impact of injuries or health conditions; or it can reduce avoidable emergency and healthcare utilization.“
Researchers from the Wakely Consulting Group studied MA and original Medicare performance compared for the American Health Insurance Plans (AHIP). According to the findings, MA plans were selected by half of racial and ethnic minorities and had greater ethnic diversity than traditional Medicare. About nine million MA insured live below the federal poverty level. MA enrollees were more satisfied with their care. Lastly, MA plans outperformed original Medicare on all sixteen clinical quality measures.
Let’s get real here, many of the same providers and facilities sign contracts with Medicare and MA companies. I question that MA insureds are getting different care than original Medicare patients. In my humble opinion, that difference here is MA plans focus on the whole person and community in addressing the social determinants of health and overcoming the health inequities in our system. MA plans are innovators. They use data and technology to proactively identify and aggressively address the social needs to reduce the need for more costly and intensive skilled care. MA plans are paying utility bills, providing transportation, and home delivered healthy meals, addressing home safety needs, and using staff to coordinate care.
Innovation and Data Sharing are Key to Successful Long-Term Care
The Commonwealth Fund released a new study comparing long-term care systems of other developed nations to the USA. The authors highlight that other wealthy countries embrace comprehensive and affordable long-term care innovation. According to the research, one-third of all seniors will require some form of long-term care costing well over one-hundred thousand dollars today. Workforce shortages further restricts the supply of skilled care and drives up the cost of care. We need a stable funding mechanism that doesn’t rely on family caregivers and seniors ‘pulling themselves up by their bootstraps.’
MA is transforming original Medicare. Home and community-based services (HBCS) can transform Long-Term care as well. The Administration for Community Living, which sits at the intersection of many federal Centers, is the right leader for national long-term care. The change is happening, slowly. I encourage all HBCS, private and public agencies and insurance companies to commit to collecting and sharing client SDOH data. The Trusted Exchange Framework and Common Agreement is a huge development to this end. The CMS Social Determinants of Health screening tools for food insecurity, housing and homelessness, transportation, utility and home repair, exploitation and neglect of vulnerable people are free to use The TEFCA framework is the trusted information exchange for sharing the findings and coordinating services. It is my hope that HBCS are ready for this transformation. National Council on Aging released a roadmap for the change, NCOA Public Policy Statement.
Let’s get to work!