Look forward as we celebrate Medicare’s past

Medicare is celebrating its 50th birthday on July 30.  Many are rightly celebrating the accomplishments of Medicare over five decades in improving the health status and health security of America’s seniors. 

However, celebrating the past shouldn’t distract us from the serious challenges presented by the future nor blind us to the opportunities to make changes. 

{mosads}The Medicare population continues to grow, projected to reach 81 million people by the year 2030. Further, this important program will support an increasingly diverse population of seniors and vulnerable patients. And with many of these beneficiaries managing multiple chronic diseases, coupled with the cost of medical care and prescription drugs continuing to rise, we are faced with an unsustainable spending trajectory.  Without serious intervention, these trends will overwhelm the Medicare system and risk reversing the gains we’ve seen over prior decades.  

Health and Human Services (HHS) Secretary Sylvia Burwell renewed the push towards value-based payment models with the recognition that integrated care models that take into account the health of the whole person are not only more effective from a health quality perspective, but also more cost effective.  

One program that does exactly that and has done so successfully for years is Medicare Advantage. 

Medicare Advantage is enormously popular among seniors because it offers more coverage options, predictable costs, and an approach that encourages providers to intervene early to prevent and treat disease before it becomes more serious.  Particularly for the growing number of low-income beneficiaries who rely on the program, Medicare Advantage is a vital coverage option that supports both quality of care and quality of life. 

The true advantage of the program is well documented.  A 2013 study published in Health Affairs found that Medicare Advantage plans’ performance on measures for breast cancer screening, diabetes care, and cholesterol testing for cardiovascular were consistently better compared to fee-for-service Medicare. Studies have also found Medicare Advantage enrollees consistently have lower rates of hospital readmission and receive more appropriate care than beneficiaries in traditional Medicare. 

That’s why policymakers on both sides of the aisle recognize the benefits that accrue to their constituents because of their enrollment in a Medicare Advantage plan.   Given all these factors it is surprising that Medicare Advantage must fight an annual battle to ensure that it receives adequate payments to deliver the kinds of services policymakers say they want to encourage in the healthcare system, especially when Medicare Advantage plans are now bidding at rates that are equal to or less than fee-for-service Medicare. 

Rather than pillory Medicare Advantage, as some have done, we should hold it up as a model of transformation, not only for Medicare, but for the health care system as a whole.   

Long gone is the belief that a fee-for-service approach to care is desirable or sustainable.  We also know that health care is a uniquely complicated and that changes to the system take years to implement and adapt.  Medicare Advantage is a time-tested program that is working, evidenced by the fact that it continues to grow in popularity as an option and that seniors report overwhelming satisfaction with the program.  We need to build on these advancements, not fall back on antiquated models of care delivery.

Let’s take a moment to recognize the tremendous progress we’ve made in attending to the health of seniors to celebrate the fact that we had the wisdom to create the Medicare program 50 years ago this month.  At the same time, let’s look forward to a more modern and holistic approach to care that holds the promise of health, quality, and affordability.

Durham is interim CEO at America’s Health Insurance Plans (AHIP).