306 Panel: What Can the Field Learn from Medicare Advantage Innovation

Stakeholders are recognizing Medicare Advantage (MA) as a major innovator in the alternative payment space, and the effects that these innovations are having on patients, providers, and payers both within Medicare Advantage and across other markets. In addition to wanting to better understand these innovations themselves, many are asking how these innovations, and strategies that drive them, can translate into other product lines. For example, health plans, via their MA products, are increasingly supporting partnership with providers by offering administrative support in the form of data analysis, and other general administrative and organizational support. On the other side of the equation, providers in MA are taking creative and successful approaches to consumer engagement, care coordination, and coordinating with specialist, enabled via the flexibility afforded by the program. For some provider practices, MA creates the foundation for an ideal ACO model, in which there is an infrastructure that allows practices to be reimbursed for numerous patient services and programs that would not be feasible in a FFS Medicare arrangement, such as hospitalist programs, transition of care programs, and diabetes and nutrition services. Despite these many advantages, there are also concerns related to the program. For example, health plans are facing the frustrating effects of being unable to conduct long-term planning for MA, due to the annual risk and price adjustments.

This session will feature payers who offer MA products, as well as providers in MA plans, speaking about the opportunities afforded by the program to not only meet the objectives improving care while lowering costs but also how their participation in MA has affected the way they design payment – and the subsequent impact on delivery – in other products. Panelists will address the following questions:

• What are the payment and care delivery innovations in MA that have been successful in improving quality and reducing costs?
• How can MA provide lessons on what characteristics of plan design and adoption are transferable to FFS, commercial products, and across different markets and environments?
• How does the structure of MA promote better partnerships between plans and providers?
• What is it about MA that patients find most valuable?
• Are there policy-level adjustments – to payment, quality measure alignment, other aspects of the program – that would elicit improvements in both outcomes and costs?

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