Latest News on the Medicare Advantage Program

Director of Medicare plans the future

One of the most important leaders in the Centers for Medicare and Medicaid Services (CMS), Dr. Meena Seshamani, is optimistic about the future of the home health care industry.

He detailed why last month at the Home Health Care News Capital + Strategy event, noting that more attention is being paid outside of traditional facilities, innovative care models and the shift towards value-based care in general.

“At Medicare we are looking to increase our footprint in values-based care and holistic care models where you are really encouraging this approach to team-based care,” Seshamani said. “You’re allowing suppliers to come together to take responsibility for cost and quality.”

Seshamani is the Deputy Administrator of CMS and the Director of the Medicare Center. In a value-based care model, the shared goal of keeping patients healthy in and out of the hospital drives smarter spending, he said. More importantly, it will ideally put suppliers, payers, and other stakeholders in a position where they all “row in the same direction.”

“When something works in innovation, we have data, we have transparency,” he said. “As you align the different models that exist, as you grow those models, that allows for some of the flexibility to be able to meet the needs of the people you care for.”

Once the data and innovative projects are in place and the alignments are successful, Seshamani said the next step is to scale them.

An example of a successful pilot model is the home health value-based (HHVBP) purchasing model. A creation of the Medicare and Medicaid Innovation Center (CMMI), the model will be expanded nationwide next year.

According to Seshamani, there are two questions that CMS needs to ask before launching any model: whether it improves quality and whether it saves money on Medicare.

HHVBP is one that meets both of these criteria. Seshamani said CMS is now scaling it in order to bring it to more people.

“Think about trying things out with the look at,‘ If it works, we can climb it. ’Because there are a lot of riders who were great as riders but then couldn’t climb,” Seshamani said.

When it comes to growth and alignment in the home health space, Seshamani said CMS will want to make sure it advances equity, encourages quality, person-centered care, and promotes sustainability of the Medicare program.

Medicare optimization is another key for Seshamani and the rest of his team. She believes Medicare Advantage (MA) will play a major role in this in the coming years.

“With that in mind, [we’re] Thinking about where and how you are innovating Medicare Advantage: Where do things work? Where are some things that might not work so well? “She said.” Is moving the needle of the results? Is spending the Medicare dollar smart?

The MA will undoubtedly be an important part of where the health system is going, and where the home care sector is going, over the next decade. Over the past two years, however, home health agencies have become increasingly skeptical of MA.

Seshamani said that as MA grows, more oversight will be needed, especially on things like supplemental benefits.

However, Seshamani said the most important thing he expects in his role at CMS is how to move the needle in innovations in care delivery and holistic care models to “advance equity, improve quality and being the best administrators of the Medicare dollar. ”

“I think this really has to happen in collaboration with suppliers,” he said. “If you have vendors working to achieve these goals, we need to be able to make it easier to connect the points.”

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