DALLAS — Long-term care providers may not have had all their questions answered Wednesday morning when Medicare executives spoke at a major employer conference, but they were given clear direction.
In short, expanding the use of health data and the voices of health care providers themselves is one of the best tools available to achieve change in a system that is increasingly reliant on Medicaid Advantage and other frustrating programs. should be considered.
“We need data… We need to understand what has been tried and what is working,” Meena Seshamani, M.D., director of the Centers for Medicare and Associate Administrator for the Centers for Medicare and Medicaid Services, said during the session. . At NIC 2024 Spring Conference.
Seshamani avoided getting into the weeds in many of his responses, but made clear that federal officials expect providers to improve the amount and methods of data collection and provide more direct feedback.
“Help us think about what the next metric should be, so we can work on this together,” she said, adding that new quality measures and better managed care policies could help. He talked about the formulation of
Data is key, she and the other speakers at the session agreed.
“There’s a huge opportunity for us as a sector because we’re essentially looking at Medicare beneficiaries 24/7,” said Co-Founder of NIC and most recently Co-Founder and Fellow of Nexus Insights. said one Bob Kramer. “And we monitor 51% 24/7.” [of beneficiaries now in MA plans], many things included in ACO plans. Therefore, we have a great opportunity to collect data. ”
Kramer said this is especially important as long-term care and eldercare move “from the sidelines to center stage” in the public policy arena.
“If you remove the noise, [data] We will be able to better see where the gaps and opportunities are,” Seshamani explained. “You are building partnerships and finding ways to care for our communities. What should we measure? The regulatory effort has just begun, not finished.
Among other roles, Mr. Seshamani oversees the Center for Medicare and Medicaid Innovation, which is focused on testing new models and metrics.
In some ways, her presence at the conference was seen as a victory for organizers, who saw it as sincere support from federal health officials.
Over the past two years, CMS has worked to address some of the most frequently raised concerns by skilled nursing departments and their residents, including burdensome and repetitive prior authorization requirements and curtailment or denial of skilled nursing services. Most recently, the agency proposed a new appeals process for residents denied coverage and issued a request for information on what new data should be collected on MA practices.
Medicare Advantage Persistent Concerns
said session moderator Dr. David Grabowski, a professor at Harvard Medical School. mac knights Then, Medicaid Advantage policies must evolve for the well-being of both providers and beneficiaries.
“We need to address issues of prior authorization and denial of care,” he said. “As someone asked, wouldn’t younger seniors be attracted to Medicaid Advantage if they have vision or dental benefits? But for the oldest seniors, it just doesn’t work.” Calculations will be made and my hope is that some changes can be made in terms of how MA deals with the post-acute phase and otherwise adequately supports beneficiaries. I can not do it.”
He reflected on the many beneficiaries who have tried to resist the constraints of the MA.
“There’s a reason someone goes back. They want to go to the SNF or rehab facility they want to go to,” he said. “Medicare Advantage, by definition, is about control over that care and where you go and how much you receive.”
Despite providers’ general concerns about increasing MA plan preference among beneficiaries, Mr. Seshamani reiterated to attendees how important beneficiary choice is. It reminded me.
“It is important that every part of the Medicare program works for beneficiaries to ensure they receive the care they need and are entitled to under Medicare,” Seshamani said. mac knights. “Starting in January 2024, we will implement changes to Medicare Advantage prior authorization to ensure that beneficiaries have access to the same services in MA as traditional Medicare, including post-acute care, and to We look to our partners to help implement these changes effectively.”
Grabowski emphasized that CMS is looking for providers to help it.
“[They] “We want to address some of the issues of care denial and prior authorization,” he said. “But we need health care providers to be involved, to tell them where the pain points are and to show examples of how beneficiaries are not getting the care they need. I am.”
