Premier responded to the Centers for Medicare & Medicaid Services (CMS)’s Request for Information (RFI) on Medicare, highlighting opportunities to strengthen the quality and sustainability of the Medicare Advantage (MA) program for plans, providers, and Medicare beneficiaries.
In its comments Premier asks CMS to consider the following as it contemplates developing data-driven policy change in the MA program:
- Leveraging value-based care models and unleashing data to reduce disparities in care;
- Streamlining prior authorization in MA to reduce provider burden and ensure access to medically necessary care;
- Improving access to telehealth and allowing diagnoses captured through audio-only telehealth visits to count toward risk adjustment methodologies across Medicare payment models;
- Creating new incentives to encourage MA plans to enter value-based contracting arrangements with providers;
- Collecting and analyzing data on MA plans’ value-based payment model requirements to promote greater alignment;
- Improving alignment of program requirements and flexibilities across MA and accountable care organizations;
- Strengthening oversight of medical loss ratio compliance;
- Preparing rural providers to succeed under alternative payment models, including in MA as managed care penetration increases, to preserve access to care; and
- Ensuring accurate and sustainable risk adjustment models across Medicare programs.