In Medicare fixes for ACA — keep the good stuff
© Getty Images

The results of last week’s election are still reverberating throughout the country, with dramatic changes proposed in almost every aspect of American public policy. Top of the agenda for the new president is healthcare and, the charge from President-elect Donald TrumpDonald TrumpPence: Supreme Court has chance to right 'historic wrong' with abortion ruling Prosecutor says during trial that actor Jussie Smollett staged 'fake hate crime' Overnight Defense & National Security — US, Iran return to negotiating table MORE is clear: Repeal the Affordable Care Act (ACA).

For 20 million previously uninsured Americans who now have health coverage and others affected by the law, there is much uncertainty about what a replacement might mean for them.


Americans want to know if the repeal of the ACA will make it better for them to have high-quality, affordable health care. For seniors, including the fast-growing group of the Baby Boomers who are eligible for Medicare, will there be changes to Medicare?

All Americans want to know whether there can be bipartisan agreement on health ahead of a bitter, polarized battle in Washington?

For those of us in the health community of insurers, providers, aging and health services agencies and advocates undoing the ACA could mean unraveling a complex set of policies long in the making that are well underway to address cost and delivery of care.

But, there is bipartisan support for what is already working in Medicare for millions of Americans. The program is Medicare Advantage.

We have seen over the past decade, even amid a gridlocked Congress, growing bipartisan support to move away from traditional fee-for-service health care delivery to value-based care that is patient-centered, high-quality care under Medicare.

Policymakers agree that fee-for-service, the prevailing financing model in health care that rewards quantity of services provided, has resulted in a costly, fragmented health system that is really not a system at all.

Medicare Advantage with its capitated system through private insurers, quality incentives, and accountability, is leading the way to value-based care for 18.5 million beneficiaries — one-third of Medicare. 

Evidence shows that Medicare Advantage is closing gaps in patient care and improving clinical outcomes for beneficiaries.

Now, 54 percent of the Medicare population have serious, multiple chronic conditions. Their numbers are growing, and they are living longer.

In Congress, I worked with members on both sides of the aisle seeking to modernize Medicare payments and reward doctors for quality. The result has led to a transformative time in Medicare changing financial incentives to pay providers to focus on prevention and primary care, as well as integrated care in the best setting for the patient, including the home. There is significant interest in addressing social determinants of health that inhibit improved outcomes. 

Recent evidence indicates that Medicare Advantage beneficiaries are about 20 percent more likely to have an annual preventive care visit as compared to beneficiaries in traditional Medicare. Emergency room visits are 20 to 25 percent lower among Medicare Advantage enrollees and inpatient medical days are 25 to 35 percent lower. Beneficiaries report 91 percent satisfaction. 

Under Medicare Advantage, primary care teams, care coordination, disease management, home visits, and supportive services are all employed to provide better patient engagement and the best care. With flexibility and responsibility for beneficiaries’ health, the incentives shift, lifting obstacles to care, and better enabling care to be provided in the right setting, with the right provider, at the right time.

Should there be a full repeal of the ACA and no appropriate replacement, many value-based initiatives in Medicare enabled by the law could be eliminated. These initiatives include quality incentives through the Medicare Star Rating system, patient-centered medical homes that incentivize care coordination and elimination of co-payments for preventive services and primary care so important to early intervention and care management.

The ACA includes important provisions that encourage value-based care initiatives in Medicare such as bundled payments, accountable care organizations, and incentives for health outcome-based quality reporting that were included in the law to reform delivery of care.

It is essential that any repeal and replacement effort maintain these important provisions that are improving care for Americans and saving dollars for the federal budget.

U.S. House Speaker Paul RyanPaul Davis RyanNo time for the timid: The dual threats of progressives and Trump Juan Williams: Pelosi shows her power Cheney takes shot at Trump: 'I like Republican presidents who win re-election' MORE has also singled out eliminating the controversial Independent Payment Advisory Board and defunding demonstration projects that test delivery models under the Center for Medicare and Medicaid Innovation.

There are pressures on Medicare, financial and demographic, so the efforts in meeting the challenges before us matter a great deal.

Medicare Advantage, a partnership between government and the private sector to enable value-based, high-quality and cost-effective care for an increasingly complex patient population is the bright spot for a divided Washington and country.

Allyson Y. Schwartz represented Pennsylvania’s 13th Congressional District from 2005-2015 and is now President & CEO, Better Medicare Alliance, the leading advocacy coalition for Medicare Advantage.

The views expressed by contributors are their own and not the views of The Hill.