New rules implemented by CMS will create a level playing field for community health plans in Medicare Advantage, Ceci Connolly, CEO of Alliance of Community Health Plans, said.
Ms. Connolly told Becker's the organization is "thrilled" to see CMS restrict the amount MA plans can pay brokers in commission for enrolling new and returning members.
"This is a big win, first of all, for seniors, because now they're going to get, especially from local, independent brokers, good, useful information based on the quality and performance of a plan," Ms. Connolly said.
In a final rule published April 4, CMS said it will cap all broker payments beginning in 2025, eliminating a loophole that allowed brokers to collect additional compensation in add-on fees from plans.
Michael Bagel, associate vice president for public policy at the Alliance of Community Health Plans, previously told Becker's the broker payment environment was the "wild west." Smaller plans can't compete with the incentives larger organizations can pay brokers, according to ACHP.
The cap will also save taxpayers "millions in millions" of payments going to junk fees, Ms. Connolly said.
"It is going to mean for the smaller community health plans they'll be back to competing on a fair, level playing field," Ms. Connolly said.
The Alliance of Community Health Plans has a five-pillar "MA for Tomorrow" policy proposal aimed at improving the program. Capping broker payments was one goal of the program.
Now that CMS has moved on broker payments, ACHP is particularly focused on reforming the metrics CMS uses to determine Star Ratings. The alliance has identified 10 process measures that "do nothing to contribute to quality or health outcomes," Ms. Connolly said.
"Those were perfectly fine metrics at the start of the MA program, but we know that it can be much better, really with a focus on health outcomes and patient experience," Ms. Connolly said.
The Alliance of Community Health Plans represents 27 nonprofit plans, most of them owned by health systems.
Ms. Connolly said some members are encountering "squeeze" from larger competitors. A few health systems have sold their health plan operations to larger nonprofits in recent years.
"We're always looking for the areas and the opportunities where there's some sort of outlier behavior, like the broker caps, and say, if we can just address that and get everybody competing on the same things, we would feel much better about that," Ms. Connolly said.
Capital investment is another challenge smaller plans are confronting, Ms. Connolly said. New technologies require big capital investments that can be out of reach for smaller organizations.
"The good news is the nonprofit plans don't have to report to shareholders. They don't have to post big profits to have a strong stock. They can take whatever margin they make and reinvest it into the business, but you're still talking about large sums of money," Ms. Connolly said.