Dr. Mehmet Oz was recently appointed as the Administrator of the Centers for Medicare & Medicaid Services (CMS) in April. His appointment has generated significant interest, but it is the work that lies ahead that truly matters, especially concerning Medicare Advantage (MA), a program that caters to approximately 33 million individuals, which makes up 54 percent of the Medicare population.
MA has the potential to deliver the best outcomes for a vast number of Americans, but it is also in need of reform. There are several crucial areas that Dr. Oz could focus on to drive substantial improvements within the program.
Here are five key areas that could benefit from Dr. Oz’s attention:
1. Pilot Multiyear Enrollment in Plans: MA plans often struggle with investments in prevention and effective treatment due to the annual turnover of enrollees. One way to address this issue is to move away from annual enrollment and introduce options for individuals to enroll in plans for multiple years at a time. This approach would provide the necessary incentives to focus on prevention, wellness, and chronic disease management, aligning with Dr. Oz’s vision of shifting the healthcare paradigm towards proactive care.
2. Standardize Plan Benefits: By standardizing plan benefits and emphasizing quality outcomes over additional perks, CMS can ensure that consumers choose plans based on healthcare excellence and effectiveness rather than superficial benefits.
3. Reform Broker Commissions: There have been discussions about reforming how MA brokers are compensated, with allegations of kickbacks and concerns about steering beneficiaries towards lower-quality plans. Aligning broker commissions with plan ratings could incentivize brokers to prioritize higher-rated plans, ultimately benefiting plan members.
4. Reform the Broker Industry to Focus More on Clinical Support: Brokers should be incentivized to provide comprehensive clinical support and care navigation services that drive positive health outcomes. Renewal fees should be tied to the provision of such services, rewarding brokers who go above and beyond for their clients.
5. Incentivize Integration Between Health Plans and Provider Organizations: Encouraging collaboration and partnership between health plans and provider organizations through global capitation arrangements can help streamline healthcare delivery and improve outcomes. A standardized framework for collaboration could benefit patients by optimizing the strengths of both groups.
The appointment of Dr. Mehmet Oz as CMS Administrator presents a unique opportunity to implement significant and lasting changes within the Medicare Advantage program. By focusing on these key areas, Dr. Oz can unlock the full potential of MA, ultimately benefiting older adults nationwide.
