Room: Phillips 403
Time: Mon 08:30 AM-10:00 AM

The Role of Private Plans in Medicare: Medicare Advantage

Chair: Frank Sloan (Duke University)

Session Description

Beneficiaries in Medicare, the federal health insurance program for the elderly and disabled, choose between two major options: traditional Medicare (TM) and a set of private health insurance plans, including managed care plans, offered under Medicare Part C. Part C has suffered severe criticism since its inception more than twenty five years ago, and remains very controversial. Nonetheless, Part C, currently known as Medicare Advantage (MA), is the main hope for modernizing Medicare through introduction of the cost and quality management techniques common in private health insurance.
To date, MA has arguably failed to achieve its objective of providing high-quality care with greater efficiency than traditional Medicare (TM). The June 2007 Report to Congress of the Medicare Payment Advisory Commission (MedPAC) concluded: “The current MA payment policy is inconsistent with MedPAC’s principles of payment equity between MA and the traditional FFS program.” Furthermore, current dissatisfaction with the fiscal performance of MA has led policy makers to propose cutting payment levels to MA plans. A well-designed MA program has the power to move Medicare into a position of leadership in health plan payment policy, while a poorly-designed program will stifle attempts at positive reform.
This session consists of papers initiating research on the economic underpinnings of Medicare Advantage.

Key Terms None

Session Organizer: Joseph Newhouse (Harvard Medical School)

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Presentations

1. An Economic History of Medicare Part C

   Presenter: Anna Sinaiko (Harvard School of Public Health)

   Discussant: Kate Bundorf (Stanford University)

2. Utilization and Quality of Care in Medicare Advantage and Traditional Medicare: A National Comparison

   Presenter: Bruce Landon (Harvard Medical School)

   Discussant: Kevin Volpp (University of Pennsylvania)

3. Potential Distortions in the Medicare Risk Adjustment System

   Presenter: Joseph Newhouse (Harvard Medical School)

   Discussant: Frank Sloan (Duke University)

4. Who Belongs in Managed Care? Using Premium Policy to Achieve an Efficient Assignment in Medicare

   Presenter: Thomas McGuire (Harvard Medical School)

   Discussant: William Encinosa (Agency for Healthcare Research and Quality (AHRQ))