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Medicare Advantage and Lessons for Healthcare’s Future

February 05, 2015
3:08 pm

(The following post is co-authored by Mary Grealy, President of the Healthcare Leadership Council, and Don Crane, President and CEO of CAPG)

As healthcare policymakers continue to seek to incentivize value in Medicare, the successes of the Medicare Advantage program cannot be ignored.

The Healthcare Leadership Council and CAPG are strong supporters of Medicare Advantage, believing that beneficiaries will gravitate toward health coverage plans that provide them with high-quality healthcare at the most affordable costs.   A recent column in Forbes highlighted how the growing preponderance of evidence shows this to be the case, pointing out that the number of beneficiaries in Medicare Advantage plans has now hit 17 million and the monthly growth rate in new enrollments is almost double what it was two years ago.  As Dr. Scott Gottlieb wrote in the column, “(Medicare Advantage) plans offer a more comprehensive set of benefits than traditional Medicare, often plugging gaps in coverage or helping to offset out-of-pocket costs.  Seniors also prefer a network that plans offer, and their ease of use.”

(Of note, the Healthcare Leadership Council will be sponsoring a Capitol Hill briefing on Medicare Advantage on Friday, February 6, featuring experts from SCAN Health Plan, MemorialCare Health System and The Latino Coalition.  The briefing is at noon, ET and interested individuals can attend by contacting Amanda Uherek at auherek@hlc.org.)

The impact on the healthcare system as a whole from the growing popularity of private Medicare Advantage plans is a positive one.  A study published in Health Affairs examined the rate at which different types of Medicare beneficiaries accessed preventive care services.  Just over one in four enrolled in traditional Medicare fee-for-service had annual preventive doctor visits.  For those in private Medicare plans, however, was 44 percent.  The more we can increase adherence to preventive care, the more we can reduce costs associated with hospitalizations, emergency room visits and acute care services.

Given the evidence, it seems odd that there is still controversy surrounding Medicare Advantage.  This is the case, though.  Despite the popularity of this program with seniors, Medicare Advantage has been the subject of repeated year over year cuts.  These cuts have come from a variety of sources – legislative and regulatory – and more cuts are on the horizon.

The facts are clear.  Medicare Advantage is growing in popularity among seniors who choose private plan options over traditional fee-for-service coverage.  And, most importantly, Medicare Advantage is getting results in terms of keeping people healthier and reducing the need for more expensive healthcare interventions.  There are answers here that can help address the challenges facing our nation’s healthcare system.

Important Movement on Data Sharing

February 02, 2015
10:36 am

Recently the Institute of Medicine released a report on sharing clinical trial data.  This report comes at an opportune time, when talk of health information technology, interoperability and big data are at the forefront of health policy conversations.  IOM discusses using data collected in trials to maximize knowledge gained and avoid duplicative trials.  The rationale is that this would create greater efficiency among research, and assist in more quickly determining best practices and improving patient care.  Interestingly, the IOM report was followed last week by an announcement by HHS and the Office of the National Coordinator of Health Information Technology regarding the creation of a new roadmap aimed at creating an interoperable structure for improved data sharing across the entire healthcare system.

The Healthcare Leadership Council has been increasingly involved with its members in discussing the future of data sharing, and how it will have an effect on all stakeholders in healthcare.  A number of HLC members have joined innovative data sharing initiatives.  As mentioned in the Wall Street Journal, a data-sharing website clinicalstudydatarequest.com, launched by GlaxoSmithKline, has been joined by several HLC members- Boehringer Ingelheim, Eli Lilly, Novartis, Sanofi and Takeda Pharmaceuticals.  Researchers can request anonymised data from clinical studies to further their research.

Also highlighted in the Wall Street Journal piece is Johnson & Johnson, which is providing the Yale Open Data Access (YODA) Project with clinical trial data for its medicine, medical devices and diagnostics tools.  Another HLC member, Medtronic, is engaged in the YODA project as well. Medtronic was the first company to contract with YODA, and has a great interest in seeing what fruits open science and transparency will bring.  These collaborations between educational institutions and healthcare companies present tremendous potential for healthcare improvement.

The IOM report also discusses barriers to data sharing, such as infrastructure, technology, workforce and sustainability, which certainly need to be taken into consideration.  Collaboration across the sectors is vital for creating the perfect environment in which to exchange data efficiently and advance medical knowledge.  Precise policies establishing productive and principled frameworks for these collaborations will help unlock the true potential of data analysis to elevate healthcare quality and cost-effectiveness.