Physician Patient

Minnesotans to lose Medicare Choices in 2019

Re: http://www.startribune.com/big-medicare-shift-coming-to-minnesota/486297431/

The advice to “Stay calm, and check your mail” from Minnesota Council of Health plans CEO Jim Showalter is not at all reassuring. Be skeptical when government or Big Business says not to worry about Minnesota Medicare costs or choices.

For about 400,000 Minnesota patients (consumers), the Medicare Cost Plan option is going away next year. 
Compared to other states, Minnesota has a lot of patients now enrolled in Medicare Cost plans. But it’s also true that Minnesota has a growing majority of seniors who are enrolled in Medicare Advantage plans (at least 53% https://www.medicareresources.org/minnesota/ ) compared to thoise on traditional fee-for-service Medicare.

The difference between a Medicare Cost Plus and Medicare Advantage plan is that a Cost Plus patient is able to go to a “health care provider” of her choice outside of a restricted provider network. https://health.usnews.com/health-care/health-insurance/articles/medicare-advantage-vs-medicare-cost-plans-whats-the-difference
 
Minnesota seniors will receive a huge increase in solicitations for Medicare Advantage plans. But will this result in true competition for access to quality care? I’m very skeptical. The business frenzy is due to the now dominating managed care business model in Minnesota. Whether sponsored by government, businesses or insurance companies, the managed care companies make money (profit) by ensuring the difference between the aggregate payments they take in for a population of patents and what they pay out to the care “providers” who actually treat the patients. To succeed financially, organizations (whether profit or nonprofit) must tightly control their payouts to their “provider” network (hospitals, physicians, and other health care professionals). Today, payers pass on the financial “risk” of the 10% or so most expensive patients to their “providers” through Accountable Care Organizations (ACO). Then the contracted “providers” internally restrict access to expensive and “unnecessary” health care. https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/
 
The Minnesota Medicare crunch is here.

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