Federal Policy Update Defending Medicare Advantage and Direct Contracting BY G A R R E T T E B E R H A R D T, D I R EC TO R O F F E D E R A L A F FA I R S , A M E R I C A’ S P H YS I C I A N G R O U P S
A flurry of conversation has been going on in Washington this fall regarding the alleged deleterious effects that Medicare Advantage (MA) and the Center for Medicare and Medicaid Innovation’s Global and Professional Direct Contracting (GPDC) pilot program have on traditional Medicare and accountable care organization (ACO) programs. APG has been vocal in contributing perspective to this conversation—highlighting the benefits of MA and direct contracting and setting the record straight on the claims made against both. These efforts have included sending a letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra and undergoing a public campaign to share data on the advantages of these programs.
A MISGUIDED OUTLOOK Physicians Donald Berwick, MD, and Rick Gilfillan, MD—former advisers and appointees to previous presidential administrations—recently authored a blog series for the healthcare-focused news outlet Health Affairs regarding their views of MA and GPDC. Drs. Berwick and Gilfillan outlined their concerns over what they believe to be MA’s inherent cost and payment abuses among participating physicians, organizations, and health plans, as well as their concern that GPDC has the potential to introduce these same issues into ACOs and traditional Medicare. APG has great respect for both Dr. Berwick and Dr. Gilfillan, their decades of experience, and what they have achieved and contributed on behalf of the movement toward value-based care. However, we believe that their outlook on both these programs is misguided and includes multiple inaccuracies and omissions.
THE CASE FOR MEDICARE ADVANTAGE Beneficiaries’ satisfaction with MA and the care they receive from it is an integral part of measuring the program’s impact and worth. Data show that MA ranks highly in this area. For example, Morning Consult recently found that, out of 1,200 MA beneficiaries polled, 98% were satisfied with their coverage, 97% expressed satisfaction with their provider networks, and 98% were pleased with the program’s response to the COVID-19 pandemic. This satisfaction is also revealed in the annual growth rate of MA enrollment, which reached 9% between 2019 and 2020. The Congressional Budget Office projects that MA enrollees will comprise as much as 51% of all Medicare beneficiaries by 2030.
10 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Fall/Winter 2021
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APG has been vocal in highlighting the benefits of these programs and setting the record straight.”
