Regulatory update: MA penetration rate reaches all-time high; CMS’ Verma weighs in on the future of value-based care

Ilene MacDonald, Editorial Director | October 28, 2020

RISE reviews the latest headlines that have an impact on Medicare and Medicare Advantage.

CMS data: Medicare Advantage penetration rate surpasses 40 percent

New data released by the Centers for Medicare & Medicaid Services (CMS) shows that Medicare Advantage (MA) penetration has exceeded 40 percent of the total Medicare-eligible population nationwide. Earlier data found that MA penetration rate was 36.2 percent but was revised after the Better Medicare Alliance identified discrepancies. The corrected information led to a significant increase in the penetration rate. The findings, released in CMS’ October 2020 MA State/County Penetration monthly report, shows 25,389,561 MA beneficiaries nationwide for the month of October out of a Medicare-eligible population of 62,462,094 individuals. The updated CMS figures reveal the progress MA has made in meeting the needs of Medicare beneficiaries, said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, in an announcement. “We now know that Medicare Advantage has officially exceeded 40 percent of the total Medicare population, and likely met this milestone benchmark some time ago,” she said.  

Seema Verma pens essay on future of value-based care models

Although the Center for Medicare & Medicaid Innovation (CMMI) has developed 54 payment models, only five models have shown statistically significant savings and only three have met the criteria for national expansion, writes Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS) in an opinion piece published by Modern Healthcare.

Verma says that CMMI is adjusting models based on the lessons learned, such as the requirement of accountable care organizations to take on more risk under the Medicare Share Savings Program, implementing more mandatory bundled payment programs, and providing participants with timely access to data and analytics. Taken together, Verma writes, the changes will help CMMI “correct course and fulfill its considerable promise.”

Report: MA competitive landscape requires all plans adopt digital solutions

Competition in the MA landscape is changing faster than ever before and plans that have adopted digital solutions like telehealth will have a leg up over those that are still operating in traditional ways or just beginning to invest in solutions, according to a new report by Deloitte. Success requires MA plans to become member-centric across all operations, invest in digital front-end capabilities for member engagement and digital core and enterprise capabilities to power it, and break down silos across the entire organization to fully integrate digital solutions.

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