The Medicare Advantage and Part D programs are a success when measured on metrics such as marketplace competition, consumer satisfaction and quality of care, but could be improved in a number of areas as part of continuous efforts to advance health care quality, health outcomes and health system efficiency, AHA Executive Vice President Tom Nickels told the Centers for Medicare & Medicaid Services yesterday in response to the agency’s request for information on how the programs might be improved. Specifically, AHA encouraged the agency to clarify program guidance for plans and providers in a timely manner; pay quality bonus payments irrespective of the benchmark cap; expand access to telehealth services; and allow plans to adapt benefits to the unique needs of some enrollees. In addition, AHA supports allowing plans to offer non-medical social services; adjusting the Hierarchical Condition Categories for sociodemographic factors; integrating hospice services; and extending access to special needs plans. The letter also offers policy recommendations to address high and rising prices for Part D drugs.
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