In The Spotlight

The Future of Medicare Advantage: Are We on the Right Path?

Big changes are coming to Medicare Advantage, through which 28 percent of Medicare beneficiaries now get coverage in such private health plans as HMOs and PPOs. A June 10 Alliance briefing looked at the program's chances for survival and growth. The Patient Protection and Affordable Care Act (ACA) reduced payments to Medicare Advantage plans to bring them more in line with costs under traditional Medicare. So far, however, the effects of those reductions have been offset by quality bonus payments. Also, CMS announced a change in the assumptions that results in a 3.3 percent payment increase for health plans for 2014 instead of a scheduled 2.3 percent payment reduction. Read More

Can Medicare be sustained in a climate of high and rising health care costs? Are there proposals that might improve quality of care while containing costs? A June 3 briefing, Medicare for the 21st Century, will address the sustainability of Medicare under its current design. A panel of Medicare experts reviewed proposals and provided perspectives on modernizing Medicare to improve the efficiency of the program, improve the quality of care and reduce overall health care costs. Read More

Starting in 2014, employers will be allowed to charge their workers up to 30 percent more for health insurance premiums if they don't meet certain health goals, under the Patient Protection and Affordable Care Act (ACA). An Alliance for Health Reform briefing, Worker Wellness Programs: Do They Work? explained the provisions in the law, and examined employer efforts to improve worker wellness, along with evidence about savings. What effect can tying wellness incentives to premiums have on workers, and especially less healthy workers? What does the evidence say about wellness programs and costs? Under the proposed agency rules related to the ACA provisions, what would be permitted and not permitted in wellness program design and practice? What are key concerns about implementing such programs? A distinguished panel of experts addressed these and related questions. Read More

Over nine million Americans receive benefits from both Medicare and Medicaid costing over $315 billion in health care services in the two programs combined. The dual eligibles account for 15 percent of the Medicaid population and almost 40 percent of all Medicaid expenditures for medical services; and 20 percent of the enrollees in Medicare, but 30 percent of the expenditures. Who are the dual eligibles? How does the Patient Protection and Affordable Care Act (ACA) address cost and quality of health care issues for this population? What is the office of duals? What federal initiatives are helping to improve quality, integrate care and align financing? How are the states involved in serving dual eligibles? In improving their care and coping with the high cost of care? What do the demos hope to show? Read More