As Medicare Advantage faces concerns regarding plan oversight, possible overpayments and care access, RAND researchers assembled experts to unpack potential reforms.
Published in Health Affairs Oct. 5, the study consisted of two rounds with nearly 40 panelists. They rated 15 policy reform ideas on a nine-point scale. These ideas had high-level framing and were drawn from panelist suggestions and published research. The policy list was updated between the two rounds.
While none of the proposed policies were found to simultaneously benefit all stakeholders — beneficiaries, plans and the government — the researchers identified the three “most feasible near-term reforms” that would benefit beneficiaries while not harming health plans and the government. These are standardizing supplemental benefits, limiting the number of plans an insurer can offer and reforming agent commissions.
The study’s discussion said that, working together, these reforms would simplify beneficiary decision making, would reduce government burden, could help with member satisfaction and could be clearly implemented through CMS administrative action without an MA program overhaul or complex plan coordination.
Here are the policy ideas experts rated as positive for beneficiaries:
- Increase competition between traditional Medicare and MA
- Utilization management standards
- Standardize supplemental benefits
- Reform agent commissions
- Limit the number of MA plans insurers can offer
- Enforce network standards
Here are the policy ideas experts rated as positive for the government:
- Competitive MA bidding
- Decouple risk scores from fee-for-service spending
- Revise the MA benchmarks methodology
Here is the policy idea experts rated as positive for plans:
- Default MA enrollment
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