2011 May Be Last Year Majority Of Seniors Receive Care From Physicians Outside An Accountable Care Organization

Main Category: Seniors / Aging
Article Date: 01 Jul 2011 - 8:00 PDT

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HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that 2011 may be the last year the majority of seniors will receive care from physicians not organized in a system of care. According to the Recent National MCO Analyzer: Medicare, Accountable Care Organizations (ACOs) are a central part of the Medicare-related provisions in the Affordable Care Act and have received the most attention from the healthcare industry. In addition, Medicare Advantage plans are jockeying to improve their quality ratings and risk scores in order to attract members and achieve better reimbursement.

"Although the Medicare ACOs don't begin until 2012, they have created the most buzz in this sector," said HealthLeaders-InterStudy Product Director Jane DuBose. "At the same time there are some strong Medicare Advantage plans poised to grow. Both will pull people away from the traditional Medicare fee-for-service system."

The Affordable Care Act will also lead to changes in Medicare Advantage plan design options. These options are fewer this year because of new federal rules and are likely to slim down further in 2012, according to the report.

Major changes in the Medicare Advantage landscape include:

- Continued phased reductions in benchmark reimbursements
- Phased elimination of the doughnut hole
- The implementation of bonuses tied to Star rating scores*

According to the report, Medicare will see a surge in growth as the first wave of baby boomers become eligible for the service. This wave of new enrollees will see an enrollment surge of 70 percent by 2030. This increased enrollment, along with federal deficit concerns, will prompt a significant rise in Medicare healthcare costs over the next decade.

Other topics covered in the National MCO Analyzer: Medicare include:

- Low-income subsidy
- Part D benefit
- Quality programs
- Dual-Eligibles
- Special Needs Plans
- Medication Therapy Management

*Star Rating System ties federal reimbursement rates for insurance carriers administering Medicare Advantage products to performance.

About National MCO Analyzer

National MCO Analyzer is the account manager's tool for in-depth analysis of national MCO strategies, opportunities and challenges. Profiling the country's 14 largest managed care organizations, each series includes:

- Market analysis from HealthLeaders-InterStudy's managed care market experts, along with an overview of opportunities and challenges for a plan in the year ahead.
- Key developments occurring in the vast Medicaid program.
- Medicare Advantage and Part D benefit trends.

Source:
HealthLeaders-InterStudy
Decision Resources, Inc.

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