Executive Summary: Give Medicare Beneficiaries Complete Information About Their Plans
Like millions of Americans, Mary is worried about managing her Type 2 diabetes—particularly about controlling her cholesterol and lowering her risk of developing coronary heart disease. But she cannot find reliable information on how well her current doctors, who are in original, fee-for-service Medicare, are helping patients just like her. That’s because original Medicare doesn’t track these quality measures or provide consumers with effective information.
While original Medicare leaves patients in the dark, Medicare Advantage plans are required to disclose objective ratings based on their quality of care. Mary can simply go to Plan Finder—an online portal that compares plans that offer prescription drug coverage including Medicare Advantage plans—to find plans in her area rated highly for cholesterol screenings for people with diabetes. She may find that some of these plans offer her someone who will help schedule her medical appointments, coordinate her care, and find additional support services within her community. This will help Mary choose a plan whose members are getting the recommended care for diabetes, including care that lowers her risk of heart disease. If original, fee-for-service Medicare were required to provide the same consumer-friendly, comparative-quality information as Medicare Advantage, Mary could make informed decisions about all the plans available to her, so she could choose the right coverage for her and her health condition. This would make her happier and healthier. Along with a new enrollment process for Medicare beneficiaries described in a separate Third Way Idea Brief, this effort would produce federal savings of $57.3 billion over 10 years.
This idea brief is one of a series of Third Way proposals that cuts waste in health care by removing obstacles to quality patient care. This approach directly improves the patient experience—when patients stay healthy, or get better quicker, they need less care. Our proposals come from innovative ideas pioneered by health care professionals and organizations, and show how to scale successful pilots from red and blue states. Together, they make cutting waste a policy agenda instead of a mere slogan.
What Is Stopping Patients From Choosing The Right Medicare Plan For Them?
Three main obstacles prevent beneficiaries from choosing the right Medicare plan for their needs:
- Medicare beneficiaries don’t have a clear way of knowing about the quality of the original, fee-for-service Medicare program.
- Quality measures do exist for Medicare Advantage plans, but they are overly complicated and sometimes conflicting.
- And, beneficiaries cannot adequately compare the costs of original Medicare (and accompanying Part D and Medigap plans) with the costs of Medicare Advantage plans.
Where Are Innovations Happening?
The lesson from places that have tested consumer behavior with Medicare quality ratings is that quality matters. When options are made clear, Medicare beneficiaries are more likely to choose plans that offer high quality at an affordable price.
- Sixty percent of 2015 Medicare Advantage enrollees are in plans with four or more stars, an increase of about 31% from 2012 enrollment levels. Star ratings also drive enrollment decisions for first-time enrollees and beneficiaries who switch plans.
- A study on data presentation found that most respondents are open to making high-value choices and, when presented with easily understood quality information, respondents were more likely to make the high-value choice.
- eHealth has assembled much of the critical information to assist Medicare beneficiaries in comparing coverage choices online, where beneficiaries may compare up to four Medicare Advantage, Medigap, or Medicare Part D plans.
How Can We Bring Solutions To Scale?
Congress should make the two main parts of Medicare—original Medicare with its supplemental coverage as well as Medicare Advantage—comparable for consumers based on quality ratings, while reducing the reporting burden on providers. It can do that through these five steps:
- Improve Medicare Advantage quality measurements by using population-based outcomes measures within a geographic area.
- Apply quality measures from Medicare Advantage to original Medicare.
- Ensure that the consolidation of provider quality measures reduces the reporting burden on providers.
- Direct Medicare Administrators to overhaul Plan Finder in order to provide accessible cost and quality information to inform beneficiary enrollment decisions.
- Make it easier for beneficiaries to act upon their choices once they find their preferred plan on Plan Finder.
When combined with Third Way’s proposal to change the default enrollment for new beneficiaries, this proposal will save the federal government $57.3 billion over 10 years.