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Donald Berwick, MD, MPP, a pediatrician, was the administrator of the Centers for Medicare & Medicaid Services (CMS) during the Obama administration and is president emeritus and senior fellow at the Institute for Healthcare Improvement.
MedPage Today interviewed him by phone about his concerns that too many Medicare beneficiaries are being misled into enrolling into private Medicare Advantage plans, which he said should be slowed or stopped because the plans have gamed the system to receive billions more than what is spent for traditional Medicare beneficiaries' care.
Cheryl Clark: Let's start with the big question. Medicare Advantage, or MA, plan enrollment has been growing so fast; 52% of beneficiaries are now enrolled, with 60%, 70% projected in a few years. Michael Chernew, PhD, chair of MedPAC, said some parts of the country are at 90%. I hear a traditional Medicare patient can't find a primary care provider in some parts of the country because all the doctors are locked in MA.
Will every eligible beneficiary have no choice but Medicare Advantage? Was that the goal of Congress to privatize Medicare entirely? And is that a good idea, given your concern about how MA plans have gamed the system to get more money?
Don Berwick, MD, MPP: I think MA growth should be slowed or stopped, at least until we end the extraordinarily high subsidies for MA plans, which are unfair to traditional Medicare and burdensome to the public treasury and many beneficiaries. Many beneficiaries can get better care for themselves and greater choice through traditional Medicare, and that option should remain robust and available.
I don't have a crystal ball, but Medicare Advantage is growing very fast. Some of the systems that apply to Medicare, like the benchmarks that are set for Medicare Advantage or the quality scores, are predicated on traditional Medicare foundations. As traditional Medicare shrinks, some of the original ideas behind comparing traditional Medicare to MA that are the basis for payment become unsustainable. The traditional Medicare population will become less desirable for insurers, meaning more expensive to treat. If everyone eventually ends up in Medicare Advantage – I can say with certainty that was not the intent of Congress when MA was set up.
The original idea behind MA, in its predecessor forms, was not a bad one. It was to give beneficiaries the choice to have what I call good, responsible managed care if they wanted it, but not require them to have it or trap them into it. It didn't take many years for that to be distorted.
[EXTERNAL LINK] - Obama CMS Chief: Medicare Advantage Plans Game the System
MedPage Today interviewed him by phone about his concerns that too many Medicare beneficiaries are being misled into enrolling into private Medicare Advantage plans, which he said should be slowed or stopped because the plans have gamed the system to receive billions more than what is spent for traditional Medicare beneficiaries' care.
Cheryl Clark: Let's start with the big question. Medicare Advantage, or MA, plan enrollment has been growing so fast; 52% of beneficiaries are now enrolled, with 60%, 70% projected in a few years. Michael Chernew, PhD, chair of MedPAC, said some parts of the country are at 90%. I hear a traditional Medicare patient can't find a primary care provider in some parts of the country because all the doctors are locked in MA.
Will every eligible beneficiary have no choice but Medicare Advantage? Was that the goal of Congress to privatize Medicare entirely? And is that a good idea, given your concern about how MA plans have gamed the system to get more money?
Don Berwick, MD, MPP: I think MA growth should be slowed or stopped, at least until we end the extraordinarily high subsidies for MA plans, which are unfair to traditional Medicare and burdensome to the public treasury and many beneficiaries. Many beneficiaries can get better care for themselves and greater choice through traditional Medicare, and that option should remain robust and available.
I don't have a crystal ball, but Medicare Advantage is growing very fast. Some of the systems that apply to Medicare, like the benchmarks that are set for Medicare Advantage or the quality scores, are predicated on traditional Medicare foundations. As traditional Medicare shrinks, some of the original ideas behind comparing traditional Medicare to MA that are the basis for payment become unsustainable. The traditional Medicare population will become less desirable for insurers, meaning more expensive to treat. If everyone eventually ends up in Medicare Advantage – I can say with certainty that was not the intent of Congress when MA was set up.
The original idea behind MA, in its predecessor forms, was not a bad one. It was to give beneficiaries the choice to have what I call good, responsible managed care if they wanted it, but not require them to have it or trap them into it. It didn't take many years for that to be distorted.
[EXTERNAL LINK] - Obama CMS Chief: Medicare Advantage Plans Game the System
