Growing Need for High Quality Care

With the share of beneficiaries enrolled in Medicare Advantage (MA) at roughly 50%, a growing need exists to address the challenges involved in providing high-quality care to these enrollees. Although MA initially insured healthier beneficiaries than traditional Medicare, it currently covers an increasing number of people with more serious illnesses requiring special needs plans. With a growing number of black and Latinx enrollees in these plans, care deficiencies may also exacerbate racial and ethnic disparities in quality and outcomes. In an effort to cover beneficiaries with more complex needs, plan administrators struggle to manage costs, which can lead to coverage denials, narrow networks, and prior-authorization requirements that can undermine enrollee access to necessary or high-quality care.

A recent article in NEJM by Professor of Health Care Policy, David Grabowski and co-authors, titled “Addressing Serious Illness Care in Medicare Advantage” suggests that a comprehensive approach improving data transparency and quality measurement would ensure improved delivery of high-quality and equitable care. There are several challenges, including insufficient data to evaluate quality of care, lack of information on supplemental benefits offered by plans, and limitations of the quality bonus program (QBP) that offers incentives for providing high-quality care.

The authors recommend improving the quality of actionable data to support transparency, critical reevaluation of the Medicare Advantage program and QBP to improve accountability and delivery of MA. Further research and creative solutions will be needed to determine the best ways to accomplish these goals. As the number of enrollees continues to grow, so does the urgent need for equitable, and person-centered care for the populations covered by Medicare Advantage.