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

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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