Warren calls for end to Direct Contracting, reforms to Medicare Advantage risk adjustment

[BeckyDem]

By Robert King Feb 3, 2022



Sen. Elizabeth Warren, D-Massachusetts, called for the Biden administration to pull the direct contracting payment model over fears it would turn Medicare over to “corporate profiteers.”

Warren also called for reforms during a hearing Wednesday of the Senate Finance Committee to risk adjustment practices she said Medicare Advantage plans are using to get overpayments from Medicare. The senator’s remarks come amid higher scrutiny of the popular MA program that has become a lucrative market for insurers.

Excerpt:

The senator was concerned that the direct contracting entity can pocket any money it doesn't spend on patient care, creating more incentives for squeezing money out of Medicare.

She said private investors and insurance companies have started to buy up providers in the hopes of using similar practices employed in MA, including up-coding to inflate beneficiary risk scores that can result in higher quality bonus payments.

https://www.fiercehealthcare.com/payers/warren-warren-calls-end-direct-contracting-reforms-medicare-advantage-risk-adjustment

( Good advice. )

[Deuxcents]

1. Senator Warren has been calling for this

For quite a while. Thom Hartman has been at it, too, telling us what a scam this is that enrich the insurance companies.

[BeckyDem]

3. Yes and hopefully we will see the advice taken to action.

Write your representatives and the WH, everyone.

[notinkansas]

2. I'm so happy this is finally getting some visibility.

A healthy dose of common sense/traction/action is critical.

[Tactical Peek]

4. When one is bombarded by millions of dollars worth of TV ads for government health care...

When one is bombarded by millions of dollars worth of TV ads for government health care insurance, it should stink to high heaven, because it means some greedheads are living high on the hog off Uncle $ugar at our expense.

[BeckyDem]

5. Yes. They seem to run a thousand times a day.

Since the pandemic, I watch more television than usual and it is not an exaggeration to say those ads run all day and all night.

[Greybnk48]

6. I'm happy about this too. We were forced to take it,

and I've been nervous ever since. We had a really good supplemental policy through Aetna as part of a retirement package. Two years ago, my husbands former company switched to MA and said take it or leave it, so we took it.

I was really unnerved that it over-rode medicare. Everyone I have asked said that MA can refuse service, whereas straight-up Medicare cannot because MA is private.

[crickets]

7. K&R for visibility.