Private Health Plans in Medicare: What is the Record?
Recorded on April 28, 2009
Location: The Heritage Foundation's Lehrman Auditorium
Congress will soon face some big decisions on how best to
improve Medicare's performance. In undertaking this task, they will
have to address both the traditional Medicare program as well as
the Medicare Advantage program, the new system of competing private
health plans created by Congress under the Medicare Modernization
Act of 2003. This discussion on the future of Medicare Advantage
will take place within a broader debate on health care reform,
where Congress will be discussing the reform of the private health
insurance market to expand coverage, possibly with a competing
public health plan to guarantee security of coverage for those who
do not have access to employer-based coverage or other types of
government program coverage.
What do we know about the performance of private health plans in
Medicare? How do they stack up on performance measures? How do
these compare with performance with traditional Medicare in the
same local areas? What is the record of these plans on hospital
stays, co-morbidities, ER visits, outpatient and office visits,
readmissions, and most importantly, "potentially avoidable"
admissions? Examination of some recent data on these subjects and
what it means will be undertaken by two expert panelists: Jeff
Lemieux will present his findings in this area and Robert Berenson,
M.D., a former top official at Health Care Financing Administration
(now the Centers for Medicare and Medicaid Services), will provide
comments and perspective.