Managed Care - September 2008 - (Page 25)

been sharpening their knives and arguments against closely say that the new law isn’t a mortal blow for private Medicare for several years. Confronted by insurers, particularly those big insurers like Huthe demands of doctors facing a steep cut in paymana, Aetna, and WellPoint that already have naments, legislators from both parties combined to tional experience contracting with doctors and hosgive a veto-proof cut to Medicare Advantage costs pitals. that would funnel the money to providers instead. Indeed, federal analysts still project growing enThe changes include instituting new network rules rollment. From the CBO’s perspective, the new law for PFFS plans, adding marketing restrictions, and is likely to significantly blunt the growth of Medislicing federal support to health plans. care Advantage. Instead of the 14.3 million memNow, with the CBO projecting that the momenbers it expected to see in Medicare Advantage plans tum behind Medicare Advantage will slacken sigby 2013, budget analysts say that number is likely nificantly in the aftermath of the recent legislation, to come closer to 12 million — a 2.3 million difthe focus is already shifting to the next big deference. The CBO concluded that the bulk of bate over MA: Will legislators will shine a Medicare Advantage’s no-shows — 1.8 milharsh spotlight on the higher cost of providlion of the 2.3 million member projected ing care through Medicare Advantage comshortfall — would be dissuaded by the pared with the traditional federal program. changes ahead. The future of a multibillion-dollar manUntil now it would have been easy to “wave aged care market will depend on which path a wand and offer coast-to-coast coverage,” Congress chooses: Take an axe to it or oversays McGill. “Now health plans are going to haul the physician payment system so that have to go back and find doctors to sign a Next year will see Medicare Advantage can stay on course. contract.” That means getting started in 2009 more congres“Medicare Advantage has exploded,” says sional assaults on to make the 2011 deadline. Rick McGill, the head of retiree medical con- insurers, says “Health plans say that’s not a big deal,” he sulting for Hewitt Associates. One of the pri- Bob Laszewski, a adds. “They say we will merely need to exemary reasons is that health plans offering pri- health care policy cute the contracts to get it done.” analyst. vate fee-for-service MA coverage didn’t need to piece together provider networks. Anyone in the Here we go again? plan could see any doctor or go into any hospital “Employers had really become more interested that agreed to accept the payment terms. in the Medicare Advantage program,” says Jonathan That allowed insurers to set up these plans all Nemeth, a senior vice president and actuary at Aon over the country, and many employers that provide Consulting. retiree health care were happy to sign up. “Now, when I talk to people, it’s here we go again. Insurers now will be required to put together This is a first step with more to come in terms of networks in all areas where at least two plans are ofcutbacks.” fered, a move that excludes regions with little comMedicare Advantage could suffer now that the petition. Those new networks have to be in place in American Medical Association has successfully 2011, giving plans a significant amount of time to learned how to cast the debate as a choice between do the groundwork. providers and plans. Add to that the looming inThe legislation also axes stabilization funds for solvency of Medicare, the projected surge of regional plans and slices indirect medical expenses boomers into the program, and a swelling federal to providers, which helped to pay teaching hospideficit, and Medicare Advantage looks even more tals. The other big change was a clamping down on endangered. insurers accused of fielding salesmen willing to say “It’s unfortunate,” says Nemeth, “because there’s just about anything to persuade seniors to sign up. a large contingent of people in these plans, and the As of next year, door-to-door sales and telepeople in them tend to like them. marketing are off-limits — a move widely endorsed “There may be a downward cycle after 2009 by all camps. where we see less and less money,” adds Nemeth. A variety of benefits analysts who follow the field “The election is the key. There is a sharp philo- SEPTEMBER 2008 / MANAGED CARE 25

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.