Smaller Medicare Programs Could Find Fertile Ground for Growth


With a blossoming Medicare population, attention needs to be directed to small, less familiar managed care programs to see if they should be pruned or pulled up.

That was the message last week during a House Ways and Means Health Subcommittee hearing.

The main Medicare Advantage program, which enrolls a third of beneficiaries in managed care, has sprouted a few offshoots targeted at special groups of beneficiaries, those particularly ill and/or lacking in financial resources.

It was on the following three programs that the subcommittee shined its spotlight.

The Program for All Inclusive Care for the Elderly (PACE) provides services for beneficiaries who need a nursing home level of care but would prefer to live at home.

Value-Based Insurance Design gets around Medicare’s “uniformity” requirement that requires that an MA plan’s benefits and cost sharing be the same for all enrollees. The model tests the concept that giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to groups of enrollees with certain chronic conditions will lead to higher-quality and more cost-efficient care.

Special needs plans (known as SNPs and pronounced “snips”) are for three types of beneficiaries—dually eligible for Medicaid, chronically ill, and institutionalized.

The mission of the hearing’s four witnesses was split. Two defended programs with which they’re associated and two questioned whether and how the programs have helped beneficiaries.

The hearing didn’t yield a bumper crop of conclusions. But what’s for certain is that there’ll be more to come on these programs.

A PACE regulation that would attempt to ease operations and encourage growth for the program was proposed 10 months ago but the final form is still germinating at the federal health agency.

The budding VBID model is being tested in seven states this year and will be expanded to three more in 2018. No decision has been made on whether it should take root nationally.

The future of SNPs is already heating up. Six groups, including three representing insurers, wrote to House lawmakers this month asking for permanent authorization of some aspects of the program along with some changes. The latest authorization for SNPs expires at the end of 2018. That’s when it must be decided if SNPs will be snipped.

Read my full article on the hearing here.

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