Nursing home executives interested in how Medicare will be discussed in the 2020 presidential race need to start focusing on this year’s Congressional agenda, which will range from drug pricing to Medicare Advantage plans, experts said Thursday.
“There’s time to shape the debate,” said Elizabeth Carpenter, Avalere Health Practice Director, Policy, in the company’s 2019 Industry Outlook discussion Thursday. “It’s important to underscore that the debate will shape what the Democrats put forward in 2020, and could influence a presidential agenda if we see a shift in power.”
But nursing home stakeholders also should recognize how much change is happening at the state level, where Medicaid policy in particular has been under scrutiny.
“Several states have approval to implement [Medicaid] work requirements, and we expect more to be approved,” Carpenter noted.
States now recognize they have a “spectrum of tools to shape their insurance market” and are definitely “not sitting by the sidelines” when it comes to drug transparency and pricing. California, for example, made news this week when newly elected Gov. Gavin Newsom (D) signed an executive order that places the purchasing of drugs for Medicaid beneficiaries under state control. This means Medicaid managed care plans now have far less clout over what can be included on their formularies.
For providers focused on Medicare, the Medicare Advantage plan options now make up a third of the Medicare market and are offering increased flexibility, Carpenter noted.
“What the data has shown is that plans are not only offering new types of benefits, but are doing more that’s historically permitted,” she said. For providers and stakeholders, there’s no way to ignore MA.
“For providers and manufacturers, the growth and popularity of Medicare Advantage means new imperatives for managing services and patients, but also gives an opportunity for partnership,” she said.
Providers also should keep an eye on vertical integration and M&A activity, cautioned John E. Linnehan, Practice Director, Health Economics and Advanced Analytics at Avalere. This includes CVS and Aetna, and Cigna and Express Scripts.
“These organizations will have more leverage in engaging with providers, and in manufacturer contracts,” he said. Providers also will be increasingly employed by larger organizations, and can expect to see more focus on the merging of claims data.