Incentive backer promotes Medicare Advantage changes

But encouraging low-risk patients to get the same services could waste plan money and, in some cases, push the patients to get care that is more likely to hurt them than to help them, Fendrick told congressional staffers, according to a summary of his remarks provided by the center.

Today, Fendrick said the nondiscrimination rules governing Medicare Advantage plans — alternatives to the traditional Medicare plan run by private insurers — keep the plans from giving incentives for care to some groups of patients and not to others.

“If Medicare Advantage plans were to encourage use of a certain service by lowering copays, they must lower copays for everyone in the plan, even though the clinical appropriateness may vary,” Fendrick said.

Letting plans lower copayments and coinsurance rates for certain high-value services for specific groups of enrollees could help the plans offer higher quality care more efficiently, Fendrick said.

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