As payers gathered at the America's Health Insurance Plans annual conference on Medicare, Medicaid and dual eligibles this week, hot topics included the promises of Medicare Advantage, the role of government regulation and perhaps the most timely subject: drug prices.
Here are some takeaways from the first days of the gathering, which focused on Medicare and featured current and former CMS officials.
MA plans and social determinants of health
Medicare Advantage plans have grown in popularity and profitability for payers, and now cover about 37% of Medicare beneficiaries. Enrollment this year will likely reach a record number beneficiaries, CMS chief Seema Verma told the conference.
And for the first time these plans will be able to sell supplemental benefits that aim to address issues not typically included in traditional health plan design, such as transportation, meals and adult-day care services.
While those are worthy causes, former HHS Secretary Mike Leavitt wondered if the system really knows how to tackle these issues efficiently and in ways that improve health and lower costs.
There are "very basic questions that we haven't answered," Leavitt, who worked for President George W. Bush, said.
For example, he asked, how would a plan define a community? "We still need to figure out which social determinants move the needle and when they move the needle," he said.
Marc Russo, president of Anthem's Medicare business, echoed a similar sentiment, saying that it's not enough to know the socioeconomic issues are out there. "We need to go beyond just understanding. We're just scratching the surface," he said.
A warning on specialty drugs
Drug prices, especially for specialty medications, were highlighted as a problem area.
Juliette Cubanski of the Kaiser Family Foundation said it makes sense to shift the rebates to point of sale but added there’s a need for bigger, more foundational changes to the system.
"I feel like a lot of these ideas that we're talking about are tinkering at the margins and not taking on some of the bigger structural challenges that the program should be facing," she said.
Scott Keefer, vice president of public policy for Blue Cross Blue Shield of Minnesota, agreed. "It makes for great bumper sticker politics but it’s not going to solve the issue," he said. Keefer spent years on the Hill working for AHIP and as a Congressional staffer.
It’s "frightening" how many seniors are reaching the catastrophic phase of the Medicare Part D benefit, he said.
No one "ever expected that we would have so many people going into that catastrophic spend," Keefer told the crowd gathered in D.C. on Monday.
And Larry Kocot of KPGM said, "If you think it was bad before, its going to get much worse," referring to the number of specialty drugs in the pipeline that have yet to enter the market.
Finding the right incentives
Improving care while keeping costs down starts with CMS setting the right incentives for payers and providers, Adam Boehler, director of the Center for Medicare and Medicaid Innovation, told conference attendees.
"Our job is to set the table, it's to set the right incentive structure," he said.
Boehler used 911 as an example. "If I say, 'Hey, why is it that so many people are coming to the hospital when they call 911?' Well, if you only pay 911 providers when they take people to the hospital, they're going to take more people to the hospital."
But Boehler said he won't demonize any player. "We set the incentives, so it's our fault and it's our job to change those."
Speaking more broadly, Boehler's predecessor, Patrick Conway, now CEO of Blue Cross Blue Shield of North Carolina, said employers and consumers are frustrated at the current system when it comes to cost and quality.
That frustration has led to disruption, he said, noting Amazon, Berkshire Hathaway and J.P. Morgan's decision to create their own health venture to tackle some of these challenges.
"They're so angry that they felt that they had to do this," he said. "We as an industry, and it's not just health plans ... we've got to deliver better results or we will be disrupted. We've got to feel like we're on a burning platform to deliver."