Medicare Advantage, Direct Contracting, & The Medicare 'Money Machine,' Part 2: Building On The ACO

[BeckyDem]

Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Building On The ACO Model

Richard Gilfillan
Donald M. Berwick

September 30, 2021

In Part one of this two-part post, we explored the reasons for surging growth and profits in the Medicare Advantage (MA) program and the dynamics, largely related to risk-coding games, that make MA a costly form of transfer of public and beneficiary dollars into private hands. In Part two below, we explore the approach fostered originally by the Trump Administration to implant those same dynamics into the traditional Medicare side of the Centers for Medicare and Medicaid Services (CMS) ledger in the form of the misnamed “Direct Contracting” model. We then offer policy recommendations to restore balance and efficiency to MA and further alternative payment models for traditional Medicare.

Direct Contracting: The Path To Medicare Privatization

Given an Orwellian title, Direct Contracting, launched by Center for Medicare and Medicaid Innovation (CMMI), was anything but direct. “Indirect Contracting” would have been a far more accurate name, since the cornerstone of the program was CMS’s opening the door to non-provider-controlled “Direct Contracting Entities (DCEs)” to become the fiscal intermediaries between patients and providers.



More @the link:
https://www.healthaffairs.org/do/10.1377/hblog20210928.795755/full/

[in2herbs]

1. I need some explanation on this. Even BCBS PPOs get payment by transferring public $$ into private

hands, i.e., the insurance companies. I agree insurance companies need to be watched but I don't understand how there is a threat to privatization of Medicare via MA plans as opposed to all other plans. When I went on Medicare at 65 I tried to continue with the Cigna HMO I had had for years and was told that was not an option because the govt had the Cigna umbrella under a suspension and prohibited them from writing any medicare insurance plans for a year. IMO, it's a matter of oversight of insurance companies by the govt. that will stave off any privatization.

[Backseat Driver]

2. I was initially thrilled to hear that regular Medicare would

begin covering vision, hearing, and dental health expenses for seniors. Now it seems it would be phased in through 2028. Unfortunately, we're not rich nor without health concerns moving into our 70s.

Currently DH and I have regular Parts A & B and a private Part D plan whose formulary keeps getting more restrictive (The premium is down just a bit). I thought the larger COLA adjustment would help us but now I'm not so sure that Joe's plan to cover vision, hearing, and dental won't suck that away. I hate the idea of switching to a MA plan that does cover those quality of life senior issues because, although Medicare approved, these are IN FACT PRIVATE CORPORATE insurance programs with much of the same confusing and expensive copays, co-insurance, and refusal of coverages to patients that regular Medicare and a supplemental private plan WITHOUT those quality of life coverages for seniors leaving even more confusion about additional personal policies on which to pay premiums. I'm tired of enriching those insurance CEOs and bigPharma.

Since it's time for the phone to start ringing non-stop and the mailbox to fill with solicitations during OPEN ENROLLMENT in a few weeks, this OP hasn't given me any hope at all. The senior health care "bear" is still chasing me daily, and chronic stress creates illness and then KILLS!

I was in favor of Medicare For All and single-payer to end all this confusion and industry greed. Is there any hope for us, our kids who'll end up caretakers, and our grandchildren who might suffer just with this expense let alone transitioning away from the fossil fuels??? SMH...