Alliance for health reform kaiser family foundation washington dc july 16 2007
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Alliance for Health Reform/Kaiser Family Foundation Washington, DC July 16, 2007. Medicare Advantage: Restructure Payments for Results. Joseph Antos, Ph.D. Wilson H. Taylor Scholar in Health Care and Retirement Policy American Enterprise Institute. Key MA payment principles. Capitation

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Alliance for Health Reform/Kaiser Family Foundation Washington, DC July 16, 2007

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Alliance for health reform kaiser family foundation washington dc july 16 2007

Alliance for Health Reform/Kaiser Family FoundationWashington, DCJuly 16, 2007

Medicare Advantage:

Restructure Payments for Results

Joseph Antos, Ph.D.

Wilson H. Taylor Scholar in Health Care

and Retirement Policy

American Enterprise Institute


Key ma payment principles

Key MA payment principles

  • Capitation

  • Risk adjustment

  • Competitive bidding


Why is there a problem

Why is there a problem?

  • Aftermath of BBA97

  • Regional politics

  • Flawed bidding system

  • Incomplete competition


Current rhetoric focuses on pay fors

Current rhetoric focuses on “pay-fors”

  • Willie Sutton was right—

Go where the money is!


Broader policy objectives

Broader policy objectives

  • Better value—from FFS and MA

  • Innovation in health care delivery

  • More sensible benefit structures

  • Fiscal restraint

  • Options for consumers


Treat the cause not the symptoms

Treat the cause, not the symptoms

  • Take a lesson from Part D

    • Plans bid against each other, not against benchmarks

  • Transition to full competition

    • Remember “comparative cost adjustment”?

    • FFS and MA should be on an equal footing on all dimensions, not only payment

    • Hold FFS and MA accountable for improving care delivery

    • Requires major FFS reform


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