Results from Deloitte's 2015 Study of Medicare Advantage Health Plans and Providers suggest there is great — and thus far unrealized — potential for health plans and providers in value-based care arrangements in Medicare Advantage.
While many health plans' MA enrollment may be smaller than their commercial lines of business, it represents a growing opportunity for providers and health plans to collaborate in testing value-based models, especially given the potential for care and cost improvements in this population.
Below are five findings from the report.
1. Many providers are testing value-based models through CMS. Providers reported more value-based arrangements with traditional Medicare than with MA health plans, however. As MA patient volume grows and the government relinquishes MA responsibility to insurers, providers and plans have an opportunity to work together to manage these patients.
2. Confusion between plans and providers as the industry shifts to value-based care will negatively affect both parties. Aspects of the MA program that help health plans optimize revenue are important drivers in value-based care strategies. Health plans and providers can mutually benefit by collaborating on quality and cost-reduction initiatives.
3. MA's high per-member/per-month costs and disease burden present greater opportunities for savings and quality improvements, which may incentivize providers and plans to work together to instigate value-based management models.
4. Health plans' revenue is risk-adjusted based on documented conditions of their beneficiaries. This may encourage plans to work with providers to accurately assess conditions by aligning financial incentives.
5. Provider respondents acknowledged value-based arrangements can lead to higher-quality care and patient satisfaction, but many are concerned about the potential impact on cost and staff satisfaction. Few providers said they believe value-based arrangements with health plans are a win-win.
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