Direct-contracting won't hurt Advantage business, CMMI director says

The CMS' innovation director reassured insurers on Tuesday that their Medicare Advantage business shouldn't be hurt by direct provider contracting ideas that the agency is considering to rework Medicare.

The Trump administration is looking toward new risk structures to help cut costs in traditional Medicare and move toward value-based care. Earlier this year, the CMS put out a request for information on the proposal that raised concerns from across the industry. It has worried some insurers that assume pushing providers to take on risk could cut into their bottom lines for Medicare Advantage.

But Adam Boehler, director of the Center for Medicare and Medicaid Innovation, told insurers during an America's Health Insurance Plans conference in Washington Tuesday that isn't the case.

According to Boehler, providers should take on more risk where they can and should.

Medicare Advantage "is on a good growth trajectory," Boehler said. "We all agree that not all of the Medicare population will go into MA. At least half the population will stay in fee for service."

Boehler critiqued the idea of centralized planning for traditional Medicare, maintaining that local control is more nimble and better than a national plan.

Before heading CMMI, Boehler was CEO of Landmark Health, the home healthcare startup for older, chronically ill patients. Landmark Health is a risk-based provider group that operates across several states and Boehler emphasized several times that he and other top HHS officials are interested in changing how the healthcare industry bears risk.

Boehler also said he wants to see more plans use value-based insurance design, or V-BID, which uses low co-pays to nudge patients toward clinical care that's considered better value. He said he would consider promoting the model for prescription drug plans and praised the administration's Medicare Part B step therapy negotiation.