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Alliance for Health Reform/Kaiser Family Foundation Washington, DC July 16, 2007

Alliance for Health Reform/Kaiser Family Foundation Washington, DC July 16, 2007. Medicare Advantage: Restructure Payments for Results. Joseph Antos, Ph.D. Wilson H. Taylor Scholar in Health Care and Retirement Policy American Enterprise Institute. Key MA payment principles. Capitation

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Alliance for Health Reform/Kaiser Family Foundation Washington, DC July 16, 2007

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  1. Alliance for Health Reform/Kaiser Family FoundationWashington, DCJuly 16, 2007 Medicare Advantage: Restructure Payments for Results Joseph Antos, Ph.D. Wilson H. Taylor Scholar in Health Care and Retirement Policy American Enterprise Institute

  2. Key MA payment principles • Capitation • Risk adjustment • Competitive bidding

  3. Why is there a problem? • Aftermath of BBA97 • Regional politics • Flawed bidding system • Incomplete competition

  4. Current rhetoric focuses on “pay-fors” • Willie Sutton was right— Go where the money is!

  5. Broader policy objectives • Better value—from FFS and MA • Innovation in health care delivery • More sensible benefit structures • Fiscal restraint • Options for consumers

  6. Treat the cause, not the symptoms • Take a lesson from Part D • Plans bid against each other, not against benchmarks • Transition to full competition • Remember “comparative cost adjustment”? • FFS and MA should be on an equal footing on all dimensions, not only payment • Hold FFS and MA accountable for improving care delivery • Requires major FFS reform

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