Filed Under:Health Insurance, Individual Health

Incentive backer promotes Medicare Advantage changes

(AP photo/U.S. Mint)
(AP photo/U.S. Mint)

Dr. A. Mark Fendrick -- a man who studies the effects of health plan design on patient behavior -- today told congressional staffers that "value-based insurance design" could improve Medicare.

Fendrick, a medical doctor and the director of the Center for Value-Based Insurance Design at the University of Michigan, talked about how VBID ideas could help improve the efficiency of Medicare at a lunch meeting for lawmakers' staffers on Capitol Hill.

Rep. Diane Black, R-Tenn., organized the briefing together with Rep. John Dingell, D-Mich.

Ellen Malin handled meeting questions for Black, and Greg Sunstrum handled meeting questions for Dingell.

Fendrick supports the idea that offering some types of care, such as preventive care aimed at diabetes, with no out-of-pocket costs for the patients, or unusually low out-of-pocket costs, could get patients at high risk of developing terrible, costly complications from developing the complications.

But encouraging low-risk patients to get the same services could waste plan money and, in some cases, push the patients to get care that is more likely to hurt them than to help them, Fendrick told congressional staffers, according to a summary of his remarks provided by the center.

Today, Fendrick said the nondiscrimination rules governing Medicare Advantage plans -- alternatives to the traditional Medicare plan run by private insurers -- keep the plans from giving incentives for care to some groups of patients and not to others.

"If Medicare Advantage plans were to encourage use of a certain service by lowering copays, they must lower copays for everyone in the plan, even though the clinical appropriateness may vary," Fendrick said.

Letting plans lower copayments and coinsurance rates for certain high-value services for specific groups of enrollees could help the plans offer higher quality care more efficiently, Fendrick said.

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