Successful Health Care For Mass. Seniors In Danger

Stuart H. Altman and James Roosevelt Jr., respectively Professor of Health Policy at the Heller School, Brandeis University, and President and CEO of Tufts Health Plan and board member of Massachusetts’ Health Care Quality and Cost Council, make the case to preserve government programs such as Medicare Advantage:

National health care reform is nearing the finish line. We strongly support its primary goal to insure most every American against the high cost of medical care. We also believe additional coverage costs should not add to the U.S. deficit.

Many government programs are being examined as funding sources to support reform, including Medicare Advantage, which covers 200,000 Massachusetts seniors. What is at stake is the possibility that payment cuts will be so significant they will eliminate the demonstrated ability of Massachusetts nonprofit plans to support providers’ delivery of coordinated care, which improves quality and lowers costs. As the House and Senate work to reconcile differences in their bills, in the interest of Massachusetts’ seniors, we urge our Congressional delegation to consider the House version of payment revision for Medicare Advantage plans.

Medicare Advantage programs like those in Massachusetts, which emphasize coordinated care, do make a difference. They facilitate the sharing of data that allows for comparative reporting on use and cost of services and quality of care. This reporting enables provider groups to identify group-specific trends, best practices, and opportunities for improvement of patient care. Working in concert with members/patients, Massachusetts health plans and providers develop effective medical management programs such as screening for depression, malnutrition, falls prevention, skilled nursing care management and programs for chronic conditions such as congestive heart failure.

It is not only common sense to think that patients do better when their caregivers communicate; there is evidence to support the claim. Studies conducted by Medicare and Johns Hopkins University, and Tufts Health Plan’s experience with more than 80,000 seniors, 1,300 primary care physicians, and 60 medical groups, validate the fact that collaboration and coordination of care leads to better outcomes and saves health care dollars. For example, the Johns Hopkins study revealed Medicare Advantage programs do 27 percent better than Medicare fee-for-service in preventing unnecessary hospital readmissions as well as contributing to 85 percent fewer preventable hospital admissions and emergency department visits. Without oversight of a system predicated on collaboration and coordination, seniors, particularly those with a multitude of complex medical needs, are at higher risk for medication mix-ups and other errors that occur when vital information is not routinely shared by caregivers. So what is the problem?

Both the House and Senate bills call for a reduction in Medicare payments such that overall spending under the two options—traditional Medicare and Medicare Advantage—would be similar. While that would be true overall, there could be substantially different results for plans in urban areas and those in rural areas.Whereas the House would set government rates in each area, the Senate would rely on competitive bidding between plans to set the rates. While there are multiple plans in urban areas like Boston, most rural areas have limited options. Competitive bidding in multiple plan regions is likely to reduce payments well below traditional Medicare. Thus, if the Senate version prevails, Medicare Advantage plans in the Boston and Worcester areas could witness substantial reductions in payments. This, in turn, will result in reduction or elimination of extra benefits, together with elimination of extra payments to providers for coordination of services.Most every health policy analyst believes that if we are to reduce future health care costs without seriously jeopardizing quality we must restructure the delivery of health care and incorporate these same services of better coordination, collaboration and communication. This means eliminating the fee-for-service payment system while substituting bundled payments for all the care of a patient. Two state commissions established to identify ways to lower health care spending and improve the quality of care in the Commonwealth recommended the same changes. How ironic, this is exactly the way the two largest Massachusetts Medicare Advantage plans are paid today.We need our Congressional delegation to support the House version of revising the way Medicare Advantage plans are paid. It would also be helpful if the phase-in time for the lower payment was increased from three to five years. We in Massachusetts can be proud of our fine health care institutions and physicians. We can also be proud of our Medicare Advantage plans that help to provide the best quality care to our seniors.

This program aired on January 14, 2010. The audio for this program is not available.

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Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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