Spurring Provider Entry Into Medicare Advantage

Similar to private health insurance, there is little competition in Medicare Advantage (MA). The US District Court’s recent decision against the Aetna-Humana merger is a strong signal that the current Medicare Advantage market does not favor new entry. According to the Justice Department’s expert testimony in the case, only 5.5 percent of the 284 complaint counties experienced new entry from 2012 to 2016 from plans that were not either Humana or Aetna. Yet Medicare Advantage does not have to be constrained in this way. Innovative provider groups have shown it is possible to launch an MA plan even when it may not be possible to launch a commercial insurance product. As provider groups gain experience through accountable care models, the number of organizations with the necessary skill set to manage risk and health care within a population will increase. As a result of their accountable care experience, providers are starting to explore different options to Medicare Advantage, such as CAPG’s “Third Option,” and other new models. We propose a model that is not completely new but rather is a different form of Medicare Advantage. Removing Barriers Since 1997, Medicare Advantage has tested the premise that the private sector can compete with Medicare in providing health care to seniors. Through its many iterations and refinements, two aspects of the program have never changed: First, to compete with Medicare, private companies must take over claims processing from the Med...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Health Policy Lab Insurance and Coverage Medicare Medicare Advantage value based care Source Type: blogs