The RFI seeks data-related input from the public related to all aspects of the Medicare Advantage program, including data collection and release methods, access to care, prior authorization, provider directories, and networks, supplemental benefits, marketing, care quality and outcomes, value-based care arrangements and equity, and healthy competition in the market, including the effects of vertical integration and how that affects payment.
The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Service (CMS), has issued a request for information (RFI) asking the public for feedback on how to enhance Medicare Advantage (MA) data capabilities and increase transparency. The information will support efforts for MA plans to best meet the needs of people with Medicare, for people with Medicare to have timely access to care, to ensure that MA plans appropriately use taxpayer funds, and for the market to have healthy competition.
The call for transparency comes now that MA has grown to more than 50 percent of Medicare enrollment and the government expects to pay MA health insurers more than $7 trillion over the next decade.
“Americans with Medicare who have managed care plans called Medicare Advantage should not feel like their health care is a black box,” said HHS Secretary Xavier Becerra in an announcement. “The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions. It deprives researchers and doctors of critical data to evaluate problems and trends in patient care. Transparency is key to the Biden-Harris Administration’s effort to increase competitiveness and ensure that Medicare dollars are spent on first-rate health care.”
The RFI is scheduled to be published in the Federal Register on January 30 and has an extended comment period of 120 days to encourage feedback. Comments are due by May 29.
CMS has already taken several steps to improve transparency in the MA market and the MA data RFI is the next step in these efforts. In addition to thoughts on improving MA data collection and release methods, CMS wants data-related input from the public related to all aspects of the MA program, including:
- Access to care
- Prior authorization
- Provider directories
- Networks
- Supplemental benefits
- Marketing
- Care quality and outcomes
- Value-based care arrangements and equity
- Healthy competition in the market, including the effects of vertical integration and how that affects payment
“In health care, you can’t improve what you don't know, and the way to know is with data. We need to have transparent Medicare Advantage data to see what’s working and what’s not working to inform our efforts to protect enrollees and drive high-quality care and competition,” said Meena Seshamani, M.D., Ph.D., CMS deputy administrator and director of the Center for Medicare, in a statement.