Healthcare Management
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According to Modern Healthcare (2019), Dr. Karen Davis is a health and Medicare advocate who pushed for broader coverage under Medicare and Medicaid since their inception. She advocated for expanding Medicaid to all pregnant women and children in the past and suggested a “Medicare for All” option in addition to private insurance coverage, thus creating a mixed public and private health coverage system. In her testimony on Medicare reform, Dr. Davis assesses approaches to maintaining and improving Medicare’s efficiency, quality, and financial stability. Implementation of the Affordable Care Act expands Medicare beneficiaries’ access to preventative care, reduces prescription costs, provides support to low-income beneficiaries that encourage coordinated care, and changes how care is delivered and paid for (Davis, 2012). Continuing Medicare as a benefit that is built upon the existing foundation of the Affordable Care Act is hence essential for its longevity and success. According to Davis (2012), “instead of shifting financial costs onto beneficiaries, putting the accountability of care in the hands of those directly responsible for providing that care will achieve high-quality care, good patient outcomes, and ensure that the cost of care is aligned with what the nation can afford.” In Dr. Davis’s testimony, the appended 24 exhibits can be summed up into the following significant themes surrounding features of the Medicare population and financial implications to those populations.
Medicare is a guaranteed benefit program that meets critical public health needs in working for the sickest and less fortunate populations. Exhibit 1-2 describe that the characteristics of the Medicare population are primarily made up of low-income, low savings persons with three or more chronic conditions, and a significant percentage experience health access problems because of cost or being unable to pay medical bills (Davis, 2012, p. 22). Dr. Davis records elderly Medicare beneficiaries in Exhibit 3-4 that are less satisfied with insurance and more likely to experience cost and access-related problems associated with Medicare (Davis, 2012, p. 23). As it is currently structured, Medicare works to provide access to care and financial protection for millions of vulnerable seniors and disabled individuals who contribute to their medical expenses through premiums for supplemental coverage and out-of-pocket expenses for non-covered services (Davis, 2012). Exhibit 6 and 7 covers administrative costs that are lower and more efficient (Davis, 2012, p. 24), and hospitals’ payment-to-cost ratios are less for persons with Medicare and Medicaid compared to that of private payers (Davis, 2012, p. 25). In Exhibit 17-18, the “Path to Prosperity” proposal increases the spending share as social security for beneficiaries (Davis, 2012, p.30). Additionally, with the support of Medicare and Medicaid innovations such as sponsored initiatives, Exhibit 19-24 identify solutions through supporting primary care, prevention, and wellness, ACO health model, quality improvement, payment reforms, bundled payments for care improvement, financial alignment initiatives, innovation advisors, and health care innovation awards, state innovation models, and partnerships for patients to support safer care (Davis, 2012, p. 31-33).
One major takeaway is that Medicare is a good buy: medical and administrative costs are lower than those in private insurance plans because of administrative efficiencies and the leverage Medicare exercises as the largest purchaser of health care in our country (Guterman et al., 2009). Medicare is the largest payer for health care, and it is understood that additional revenues may well need to be part of the solution. According to Davis (2012), one strategy would limit the government’s fiscal liability by converting Medicare to a premium support program and capping the growth rate of government contributions. Another approach is to transform the health care delivery system, providing significant incentives for physicians, nurses, hospitals, and other health care providers to deliver high-quality care.
References
Davis, K. (2012, October 2). Testimony—The Future of Medicare: Converting to Premium Support or Continuing as a Guaranteed Benefit Program. Commonwealth Fund. https://www.commonwealthfund.org/publications/other-publication/2012/oct/testimony-future-medicare-converting-premium-support-or
Modern Healthcare. (2019, March 2). 2019 Health Care Hall of Fame Karen Davis. Crain Communications, Inc. https://www.modernhealthcare.com/awards/2019-health-care-hall-fame-karen-davis
Guterman, S., Davis, K., Schoenbaum, S., & Shih, A. (2009). Using Medicare Payment Policy To Transform The Health System: A Framework For Improving Performance. Health Affairs, 28(Supplement 2), w238–w250. https://doi.org/10.1377/hlthaff.28.2.w238
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