AHIP CEO calls for strengthening Medicare Advantage and Medicaid managed care

Photo: Cecilie Arcurs / Getty Images

In his keynote address at the AHIP 2021 National Conference this week, AHIP President and CEO Matt Eyles called for strengthening and protecting Medicare Advantage as well as Medicaid Managed Care, calling the programs “effective, efficient and popular”.

Eyles has touted the benefits of protecting such programs, especially amid the COVID-19 pandemic.

Speaking specifically of Medicare Advantage – which gives Medicare beneficiaries access to private health plans with their own programs and benefits – Eyles said MA was a “prime example” of the public and private sectors working together to provide coverage to beneficiaries.

Eyles said insurance providers have continuously worked to improve their MA benefits and have innovated new ways of delivering care.

“They used data and analysis to better understand the health and well-being of Medicare registrants, going beyond chronic illnesses and conditions to examine the importance of safe housing, food security and strong communities, ”he said, adding that insurers have also adopted models of care focused on the overall health of the person.

These are among the reasons, Eyles said, that 27 million Americans have chosen Medicare Advantage over original Medicare for their coverage, adding that most of them are very happy with their coverage and benefits, including including preventive care coverage.


Eyles’ comments come as Congress reflects on a reconciliation plan that could affect the U.S. healthcare landscape. Package proposes to expand health insurance to cover vision, hearing and dental care, which some say will cause the program to run out by 2024 – and cost $ 358 billion over a decade , creating an undue burden on taxpayers, according to Forbes.

In a letter to Congress earlier this month from the Better Medicare Alliance and co-signed by 46 other organizations, the groups said the additional benefits should be structured to reflect the added costs of dental care, from the vision and Medicare hearing in the baseline calculation. If the cost of providing these benefits is not reflected in the benchmark, Medicare Advantage beneficiaries could see a loss of additional benefits, they said.


MA was not the only program praised by Eyles. He also focused on Medicaid-managed care, which he says is just as essential.

As Medicaid and CHIP programs provide coverage and a path to care for one in five Americans, Medicaid managed care plans serve two-thirds of them, according to Eyles – low-income families, women and men. children, the elderly, people with disabilities and veterans.

Such plans, he said, save money through patient-centered care coordination programs, increased use of generic drugs, accessible provider networks, and drug-focused programs. routine and preventive care. Managed care plans also encourage vaccinations, help people with substance use disorders overcome their addiction, and help address challenges in accessing care, such as housing, transportation, and healthy eating. .

“States chose Medicaid managed care plans as a strategic partner because managed care works,” Eyles said. “With more than 77 million Americans – nearly half of whom are children – states and plans are working together to ensure they meet very high standards of quality, value and satisfaction. As a result, 84% of registrants say they have regular access to the care they need. Both adults and children are much more likely to have a doctor they see regularly and to get preventive services to stay healthy And Medicaid-managed care provides Americans with access to home and community services, giving them the freedom to receive care at home.


AHIP considers the COVID-19 crisis to highlight the importance of partnerships with health insurance providers through Medicare and Medicaid, with Eyles placing particular emphasis on the Vaccine Community Connectors program, led by AHIP, ACAP and the Blue Cross Blue Shield Association. The program, which launched earlier this year, has helped immunize more than 2 million older people in under-represented communities in less than 100 days, Eyles said.

A January Morning Consult survey of more than 1,200 seniors on Medicare commissioned by the Better Medicare Alliance showed near universal satisfaction with Medicare Advantage coverage (98%), provider networks (97%) and management. the current health crisis (98%).

Ninety-five percent of those polled agreed that it was important for older people to have coverage options outside of traditional health insurance, and 93% said supporting a candidate to Medicare Advantage is important to their vote. Three-quarters (77%) of seniors receiving Medicare Advantage strongly oppose the federal government reducing the amount of money paid to Medicare Advantage, even though such reductions are billed as necessary to reduce costs for them. taxpayers or the national debt.

That’s not to say there aren’t issues with Medicare Advantage. Also in January, Ina Goldberg, managing partner of North Shore Insurance Brokers, said that while premiums for MA plans are lower, and sometimes free, people pay more as they get older and sicker.

Still, Eyles pointed to data showing that premiums fell 34% from 2017 to 2021 due to MAID, and that the program outperforms the original Medicare on a number of clinical-grade metrics.

A Medicare Advantage study from December 2020 found that for 2021, consumers have chosen MA for telehealth benefits as well as additional COVID-19 benefits offered by private plans.

Of those who opted for an MA plan because of additional benefits, 35% specifically cited the additional benefits of COVID-19, while 27% cited telehealth benefits, according to the report. Thirty-five percent are signed up for an MA plan for 2021 because they already had it and prefer it; 29% like prescription drug coverage; 16% like affordability; and 9% like additional benefits.

In addition, 45% are switching from an original Medicare plan in 2020 to a Medicare Advantage plan in 2021. Of those enrolled in an MA plan for 2021, 65% compared all of their Medicare options before enrolling, while 26% % did a “brief amount of research.”


“MA has also been of huge benefit to dual-eligible Americans, who are often the most vulnerable seniors,” Eyles said. “Duplicates of Medicare Advantage enrolled were less likely to experience COVID-19-related disruptions in their health care compared to duplicates of original Medicare. They were also less likely to report that they were unable to obtain diagnostic tests or medical screening, treatment for current conditions, and emergency care for accidents or illnesses during the period. pandemic. “

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