MCO Executives Testify to Congress During Medicare+Choice Hearing
As part of the House Ways and Means Subcommittee on Health's series of hearings on Medicare+Choice, the panel heard testimony yesterday from representatives of Medicare managed care organizations and experts on the reimbursement and regulatory system created by HCFA. While Republicans on the panel questioned witnesses on how Congress can improve the Medicare+Choice program by making it more "flexible," Democrats, led by ranking member Rep. Pete Stark (D-Calif.), called the program a "failed experiment," as many plans have exited the program. Health plan executives, however, said the program is popular with their members because it offers services that are unavailable in traditional Medicare, such as prescription drug coverage. While noting that some providers and hospitals would like the program to "revert" to a fee-for-service payment system, managed care's "pre-payment" option is preferable, as it allows insurers to "design a continuum of care," according to Cheryl Scott, president and CEO of the Group Health Cooperative, a not-for-profit insurer based in Seattle, Wash. She added, "When you are not paid on an encounter-by-encounter or procedure-by-procedure basis, you can shift your focus to include longer-term improvement in health outcomes." In addition, health plan executives recommended that M+C oversight be consolidated into one HCFA office, instead of the three that currently create policy for the programs. But Stark said, "It would be inappropriate and inefficient to separate out the Medicare+Choice program to a different regulatory agency." The panel also heard testimony about the impact of the current M+C reimbursement structure on plans in rural counties (Darryl Drevna, California Healthline, 5/2).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.