CMS' rewards programs can impact Medicare Advantage organization's bottom lines

CMS Policy Changes Signal Shift in Favor of Consumer Benefit Rather Than Protection

Tom Wicka, CEO of Novu, writes an interesting article on Medicare Advantage plan design strategy that is worth an attentive read.  His suggestions are well-taken.  However, to fully appreciate why this is such a shift in CMS policy, it is worth stepping back for a moment to consider what this is all about. 

Let's face it:  CMS' job is a tough one.  On the one hand, they are regulating an industry that is loaded with innovative and sometimes aggressive healthplans and their legions of downstream contracted business partners, not all of whom stay inside the fenceline.  On the other hand, they want to do the right thing by the Medicare beneficiaries and get them the most valuable healthcare that federal money can buy. The easiest solution to achieve these two goals is to install rigid, one-size-fits-all regulations with vivid bright lines, and then police the lines.  Wherever regulations leave loopholes that are exploited by some cowboy operatives, CMS can be punitive and close down the wiggle room.  Fair enough. 

Another option is to flex a bit and allow the creative and competitive forces to come up with solutions that take the high road to a more value-based level.  Such is the case with the long-anticipated incentive policy that CMS has recently promulgated.  I am sure there will be some abusers, or at least, some plans that test the limits and CMS' patience.  However, this is one case where CMS flexibility will yield significant value to members of Medicare Advantage Health Plans.  Mr. Wicka points out that health improvement opportunities, facilitated by these more flexible incentives, is what motivated CMS to take the risk.  In the wild and crazy days of Private Fee for Service plans in the 2005 to 2008 era, undoubtedly some plans would have used these tools to bait seniors into joining up when healthplans lacked the administrative tools to track and properly implement the way that Mr. Wicka envisions.  But these are new days, and CMS is a different CMS.  Let's stay tuned and see how it all works out!,2




Tags: Plan Design Medicare Advantage Incentives

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