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Payer-provider marriage can propel Medicare Advantage innovation

AHIP Health Policy conference speaker says both sides need to work in tandem

Amid the Centers for Medicare & Medicaid Services (CMS) proposal to cut Medicare Advantage (MA) reimbursement rates by 0.95 percent in 2016, payers and providers are still well-positioned to break down traditional barriers and work in tandem to invest in consumers' health, Kent Thiry, CEO of DaVita HealthCare Partners, stated during a panel discussion at America's Health Insurance Plans (AHIP) Health Policy conference in the District of Columbia.

"Medicare Advantage is part of the solution to our somewhat flawed healthcare system," Thiry said. "It's important to push for continuous innovation and improvement in order to create some stability within the system."

As Thiry mentioned, not only should payers and providers establish a communicable relationship, but both sides need to work directly with CMS to establish goals for their programs. This especially is important; since MA requirements differ for each insurer, providers must reach out to individual MA insurers each time a patient needs treatment.

"Joint ventures between payers and providers are key," Thiry added. "Establishing a good connection between the two entities, with both working as co-architects, can help set more straightforward requirements for the program."

Thiry also mentioned the importance of increasing and promoting transparency and innovation. To accomplish this, though, all sectors in the healthcare industry need to be willing to work together.

Since the CMS announcement, insurers and providers alike have opposed the cuts. The proposed 0.95 percent rate cut for 2016 would likely cost payers between 1 and 1.75 percent of their Medicare Advantage funding, FierceHealthPayer previously reported. Additionally, it would cause consumers' out-of-pocket costs to increase, as heathcare costs continue to rise while reimbursement rates fall.

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