Call to Action: Promoting Medicare Advantage as a Best Value Solution!
The recent AHIP National Policy Form in Washington, D.C. focused on healthcare reform. The panelists included some high profile political and industry figures such as Peter Orszag, PhD, Director of the federal Office of Management and Budget, Senator Orrin G. Hatch, and Ron Pollack, Founding Executive Director of Families USA. While each shared his own opinions on healthcare reform, there was one common theme: healthcare reform WILL take place very soon.
Also, each panelist agreed that any reform package’s key elements will focus on cost containment and access in a setting that likely will include both private and public plan offerings. There is much debate about publicly-run (governmental) plans and what would be needed to have a competitively fair playing field for both public and private plans.
Is the Cup Half Empty or Half Full?
Medicare Advantage plans can be viewed as at somewhat of a disadvantage in today’s dialogue. President Obama has questioned the relative value of Medicare Advantage, and the recently announced rate cuts suggest possibilities of reduced payments and increasing scrutiny by CMS.
However, according to Robert Berenson, MD, Senior Fellow of the Urban Institute, the Medicare Advantage program has a “structural advantage over the traditional fee-for-service program” since it offers one-stop shopping versus three-stop shopping (Medicare Parts A/B, Part D and supplementary coverage, all rolled into one). Further, Medicare Advantage plans historically have offered extra benefits like vision care, dental care and others to beneficiaries at zero-premium levels or at premiums that are advantageous vis-à-vis those associated with the purchase of Medigap supplemental coverage. And one also has to count the other “value added” programs, like gym memberships that many plans offer to enhance member health and quality of life.
In the 1990’s, when concepts such as “gatekeepers” and prior authorization were introduced, managed care received its share of knocks, and many cost containment proposals faired rather poorly. What if, however, the idea of a gatekeeper had been presented in the manner of a “friendly Dr. Welby,” the trusted family doctor on television at the time, who coordinated all your healthcare needs and referred you to the right specialists when necessary? Would such a Dr. Welby have received the same heavy criticism as did the gatekeeper concept, despite the fact that, functionally, they are about the same?
Making the Cup More than Half Full
Yes, the right public relations approach may serve our industry well. After all, we’re poised to address healthcare reform again, and this initiative will require that ALL viewpoints are heard and weighed seriously in the best interest of achieving results. Each viewpoint can “win” through strategic compromise and attention to the end goal: stopping spiraling healthcare cost increases and providing all Americans access to good healthcare.
As we participate in this historic conversation, Medicare Advantage plans might well consider launching positive public relations campaigns – especially among our government representatives and other opinion makers – to demonstrate the value they bring to their members and to our American commonwealth in total. Medicare Advantage has a lot to offer in creating new public healthcare policy that incorporates the very best aspects of managed care – low cost, high quality healthcare for all.
We have a great opportunity to let America know, understand and love all that is good in what Medicare Advantage plans bring to the table in the discussion of healthcare reform.
Jill Spencer
Vice President, Business Development
March 24, 2009