There are plenty of eyes on the Medicare Advantage program, and interest in reforms is growing on both sides of the aisle.
It’s with that backdrop that researchers at RAND surveyed experts about potential policy ideas and the impacts on beneficiaries, costs and more. The analysis was built using the Delphi method, in which panels are presented with multiple rounds of questioning to determine a consensus.
The panel included 52 experts, spanning researchers, the MA industry, patient advocates and policymakers. The survey didn’t identify a single policy proposal that rose to the top and would benefit all three stakeholder groups included in the analysis.
“It may not be really a surprising finding, but the fact that it’s empirically shown illustrates the complexity of changing anything related to healthcare,” said Dmitry Khodyakov, a senior sociologist at RAND and one of the study’s authors, in an interview. “There is always going to be a party that may not may not be thrilled.”
For example, one idea that would likely be most beneficial to enrollees—enhancing traditional Medicare to make it more competitive with MA—comes with clear downsides for insurers.
If original Medicare added supplemental benefits, established an out-of-pocket maximum and addressed cost-sharing, it would become a more attractive option for many. For plans, this would mean potentially lower enrollment and thus lower profitability.
But it also may not generate benefits for the government, as if payment parity isn’t baked into the shift, then savings from lower MA outlays would likely be negated by higher spending in traditional Medicare.
In particular, generating savings or improvements for the federal government would almost certainly require significant disruption of the existing MA market, making those changes a hard sell.
The surveyed experts weighed in on a list of 14 total policy ideas that was trimmed down from an initial group of 60. Still, Erin Taylor, a senior economist at RAND and another of the study’s authors, told Fierce that three themes rose to the top as potential reforms that could be implemented in the near term, as they would benefit enrollees without significant disruption for plans or the government.
These proposals include: standardizing supplemental benefits, reforming commissions for agents and limiting the number of plans an insurer can offer. These changes would simplify the decision-making process for enrollees and could likely be implemented through rule-making rather than requiring congressional intervention.
“They are kind of clustered together,” Taylor said. “They seem to address the issues that are well-documented and that complicate choice.”
And they offer an example of trade-offs that insurers can see positives from, the study found. While these changes would boost competition in the MA market, it would also support better member experience and retention, as well as reduced administrative complexity.
The report also notes that there are basically no policy updates that would fully satisfy everyone—so policymakers should be explicit about who they’re aiming to benefit with a change.
Khodyakov said that continuing to poll expert panels like this would also allow stakeholders to monitor whether sentiment has changed, or if new policy priorities may have emerged.
“This is kind of a first step along a policymaking path that we’re trying to start,” Taylor said.