DALLAS — Long-term care providers may not have had all their questions answered when a top Medicare official addressed a key operator conference Wednesday morning, but they were given some clear direction.
Namely, the increased use of health data and providers’ own voices should be considered among the best tools available for achieving change in a system that increasingly relies on Medicaid Advantage and other frustrating programs.
“We need to have data … We need to understand what is being tried, what is working,” said Meena Seshamani, MD, PhD, director of the Center of Medicare and deputy administrator of the Centers for Medicare & Medicaid Services, during a session at the NIC 2024 Spring Conference.
While she avoided getting into the weeds with many answers, Seshamani made it clear that federal authorities are counting on providers to improve their data collection volume and methods, and also to provide more direct feedback.
“Help us think about what the next round of metrics should be so we could work on this together,” she said about the formulation of new quality measures and better managed care policies.
Data is a key, she and the session’s other speakers agreed.
“We have an enormous opportunity as a sector because we have our eyes 24/7 basically on Medicare beneficiaries,” noted Bob Kramer, NIC co-founder and more recently co-founder and Fellow with Nexus Insights. “And we have eyes 24/7 on the 51% [of beneficiaries now in MA plans], and the many that are in ACO REACH plans. So we have a great opportunity to collect data.”
It’s especially critical, Kramer said, since long-term and senior care have moved “from a side stage to the main stage” in the public policy arena.
“When you take out the noise, [data] better enables you to see where the gaps and opportunities are,” Seshamani explained. “As you are forging partnerships and finding ways to take care of our communities. What are the things we should be measuring? We have started, not finished” regulatory efforts.
Among her other roles, Seshamani oversees the Center for Medicare and Medicaid Innovation, which is intent on testing new models and metrics.
In some respects, her presence at the conference was viewed as a victory for organizers, who saw it as outreach by federal health authorities.
CMS has in the last two years moved to address some of the concerns most often cited by the skilled nursing sector and its residents, including burdensome and repetitive prior authorization requirements and shortened or denied skilled nursing services. Most recently, the agency proposed a new appeals process for residents denied coverage and issued a request for information on what new data it should collect about MA practices.
Lasting Medicare Advantage concerns
Session moderator David Grabowski, PhD, a Harvard Medical School professor, told McKnight’s afterward that Medicaid Advantage policies need to evolve, for both providers’ and beneficiaries’ well-being.
“We need to address the prior authorization and care denial issues,” he said. “As somebody asked, aren’t young older adults attracted to Medicaid Advantage when the vision and dental benefits are there, but for the oldest old, it just doesn’t work. There’s going to be a reckoning and my hope is that we’re able to make some changes as to how MA addresses post-acute. Otherwise, it’s not going to support our beneficiaries well.”
He reflected on the numerous beneficiaries who have tried to buck MA constraints.
“There’s a reason somebody’s switching back. They want to go to the SNF or rehab facility they want to go to,” he said. “Medicare Advantage, by definition, is managing that care and where you can go and how much you can get.”
Despite providers’ general unease over MA plans’ rising preference among beneficiaries, Seshamani reminded attendees several times how important beneficiary choice is.
“It’s important for all parts of the Medicare program to work for beneficiaries and ensure they can access the care they need and are entitled to in Medicare,” Seshamani told McKnight’s. “Starting in January 2024, we implemented changes in Medicare Advantage to prior authorization to ensure beneficiaries have access to the same services in MA as in traditional Medicare, including post-acute care, and released FAQs and an enforcement plan. We look to our partners to ensure these changes are implemented effectively.”
Grabowski emphasized CMS is looking for providers to help themselves.
“[They] want to address some of the care denials and the prior authorization problems,” he said. “But they need providers to engage there and tell where the pain points are, and give examples of beneficiaries not being able to get the care they need. They have a comment period open and want input.”
