By GEORGE HALVORSON
A change to the 2022 Medicare Advantage data collection process made last year simply made it unnecessary and impossible for plans to code, but critics deny that happened.
CMS just ended the 2022 coding debate, completely gutting the plans’ coding system, effective immediately. Plans cannot code a risk level because the coding system has been phased out entirely for 2022.
RAPS is dead.
Medicare Advantage’s payment approach now has no decoding components, and the government simply used their new and more accurate numbers to create the 2023 payment level for plans.
The numbers went up a bit with the actual risk levels because it actually seemed like the plans were undercoded despite their best efforts to have higher numbers in their RAPS data feed.
Now we should be able to put that issue to bed and look at what the Affordable Care Act has accomplished as a whole.
The Medicare payment component of the Affordable Care Act has reached a new level, and the entire Obamacare package must now be recognized for what it is. now and what has become of it?
When the Affordable Care Act was drafted, there were people helping that process who understood that the only way to continuously improve care in America was to buy care as a package, not piecemeal, and reward organizations that — engineering care to meet those goals. so as to encourage the use of the best care delivery tools in our markets.
Medicare Advantage plans all know that clean socks and dry feet reduce foot ulcers, which cause 90 percent of amputations, by 40 percent. The programs also know that heart failure is extremely expensive and painful, and they identify high-risk patients and help them reduce their risk by doing helpful things in people’s homes to make it happen. Some plans even have scales that alert care plan nurses when people experience unexpected weight gains from fluid retention, indicating a CHF crisis is imminent.
The interventions are working at that point, and the JAMA study cited above shows that the plans have 40 percent fewer hospital admissions for both heart failure and asthma.
Blood sugar management in diabetic patients reduces blindness by 60 percent for patients who achieve that goal, and one of the most important goals of the five-star Medicare Advantage plan has always been blood sugar as a top priority. The programs even improved performance in that area under Covid conditions.
The tools used by the plans are very flexible and aimed at continuous improvement of many parameters. In those settings, overlap with other patients is significant because it is extremely difficult for caregivers to provide multiple examples of care for their patients.
The Affordable Care Act also sought to improve care for everyone, and it’s good for the country that most large employers are self-insured for their care, and it’s good that the vast majority of those employers hire administrators to manage their self-insurance.
The organizations that do that administrative work for employers tend to be the same major carriers who also own the vast majority of Medicare Advantage plans and the vast majority of Medicaid administrators, and they align with the goals of care set by the vast majority of unions. trust fund administrators too. More than 5 million union members are in their own Medicare Advantage plans, and those union plans tend to have the highest five-star Medicare Advantage quality scores in the nation.
So when the people who drafted the Affordable Care Act were doing that design work to improve care, they were looking to make that improvement spread to the rest of American health care.
This is the right time for the diffusion of best processes to happen.
We should be on the cusp of a golden age of care delivery in America.
We need to be able to use artificial intelligence and FIHR, like data connectivity systems, to do things like the cancer moonshot that’s being created now at America’s best cancer sites to make care cheaper and better for everyone. The best care team will be able to predict several types of cancer a year or earlier with simple blood tests and other monitoring devices, and this can significantly reduce the cost of care for us as a country, as stage 1 cancers cost. much less treatment than stage 4 cancer.
Fee-for-service Medicare will not support any of those improvements or improvements in care because they have never supported that level of improvement and flexibility in care. Medicare Advantage plans will now have some plans to support whatever is happening to improve care, and the enhanced care of those plans will create a competitive advantage for other plans to follow by also improving care.
It’s obviously good for everyone. That’s how markets are supposed to work, and it’s very different from how market forces work in fee-for-service American health care.
So when we look at the Affordable Care Act, the key pieces clearly support some of the things that we need to do to make care affordable for the country, and we need to understand that process and build on those successes in every area that they happen: , and we must anchor it by continually improving care for all of us.
When the Affordable Care Act was passed, health economists pretty consistently predicted that America was on a slippery slope to spending more than 20 percent of our GDP on care, and new markets that use better tools for many patients. and which create better. Procurement mechanisms in both Medicaid and private insurance appear to have had a major positive impact on that agenda.
We are now at 18 percent of our GDP spent on care, which is high, but significantly better than the 20 percent path we were on before the law was passed. The timing of those trajectories tells us it’s not a coincidence.
The problem we face today is that there are serious enemies in the process of using Medicare Capitation and Medicare Advantage to improve care.
We need to deter people who clearly and openly want to kill all programs because they believe some version of voter fraud has occurred in some quarters, from the damage that these opponents seem committed to doing. to Medicare benefits. disappear and die.
That warning about those critics shouldn’t be necessary at this point, but people who want to kill those programs and processes do exist, and that death is their open goal, and we just have to recognize what they’re doing and stop it. them. from sneaking in back doors and using various kinds of warped data streams to somehow effect those changes in ways that are detrimental to our care as a country.
Let’s celebrate Obamacare on every level there is.
The Medicaid program is a huge win.
Direct access to employment and open enrollment insurance programs and operating insurance exchanges in every state are major wins.
Capitated Medicare creates better care and does so for about 10 percent less than Medicare spends on those same patients in all those counties.
The people who lost their political careers because they got the Affordable Care Act passed should be heroes to us now because the victories today are so clear what they put in and Americans have a better life. , because those programs exist.
Thank you.
George Halvorson is president and CEO of the Institute for Intergroup Understanding and was CEO of Kaiser Permanente from 2002-14..