Experts polled in the latest Healthcare Opinion Leaders survey, conducted by the Commonwealth Fund and Modern Healthcare, favor sweeping changes to Medicare to help control program costs and support broader health system reform.
According to the survey, a majority of leaders in healthcare and health policy believe Medicare has been successful in providing access to care and stable coverage to the elderly and disabled individuals. However, only a small percentage think the program has realized its potential to achieve other important goals, like using its leverage as the country's largest purchaser of services to control costs and promote a high performance health system.
"While these responses confirm that Medicare has been a tremendous success in fulfilling its basic mission, they also indicate that it is important for Medicare to take the lead in developing innovative approaches to improving health system performance," said Karen Davis, president of The Commonwealth Fund.
Because of Medicare's unique position as the nation's largest insurance program, it can be an important testing ground for cost and quality innovations, officials said. To encourage such development, nearly all respondents favor expanding the power of the Secretary of Health and Human Services to put payment pilot programs on a "fast track" (95 percent) and work with private payers and providers to establish multi-payer initiatives (94 percent).
Similarly, there was strong support for creation of an independent Medicare advisory council (favored by 75 percent) with broad authority to collaborate in multi-payer initiatives (89 percent), develop, test and implement payment reforms rapidly and flexibly (88 percent) and alter beneficiary incentives based on effectiveness of services, drugs and devices (86 percent).
The survey asked respondents their opinions about specific policy options to improve coverage. Respondents strongly supported using Medicare's leverage to negotiate pharmaceutical drug prices (81 percent) and filling in the so-called Medicare "doughnut hole" through some combination of increased co-payments, government funding and drug price discounts (79 percent). There was also strong support (83 percent) for eliminating the two-year waiting period currently required of 1.8 million disabled beneficiaries before they become eligible for benefits.
Other findings from the survey include:
- 76 percent of respondents favor reducing overpayments to Medicare Advantage plans. Payments to these plans are projected to exceed corresponding costs in traditional fee-for-service Medicare by 13 percent in 2009.
- 65 percent feel that bundled payments and encouraging beneficiaries to designate a medical home would be effective policies for improving care and reducing costs.
- 74 percent believe older adults (ages 50 to 64) should be able to buy Medicare coverage before they become eligible at age 65.
- 69 percent favor having Medicare offer its own comprehensive benefit package option as an alternative to Medigap or Medicare Advantage coverage.
- 91 percent support a requirement that Medicare providers participate in developing state, regional and national all-payer databases to aid in research, policy development and monitoring and evaluation.
- Those polled don't favor strategies that shift costs to beneficiaries or reduce payments across the board. Only 42 percent support offering a high-deductible health plan and 36 percent approve of requiring Medicare beneficiaries to pay a higher share of costs. Capping federal spending was similarly unpopular (26 percent), as was reducing payments to providers (19 percent).