Back to the future in health care.

CMS is looking to reform Medicare Advantage Plans. There are five basic strategies. You can read all of them here. But we will focus on a few.

The thing is there is nothing new. HMOs and PPOs tried all of this except the multiyear enrollment. The argument for multiyear enrollment has some validity. But would you enroll under those conditions knowing you are locked into a specific network of doctors?

MA is insurance, not healthcare. The doctors providing care are individual practitioners who have little control over patient behavior and compliance. Patients want little in the way of managed care when it involves an insurance company “second guessing” their doctor. There is nothing new about that either.

Providers for the most part are not interested in payment by capitation. That was tried back in the 1980s. CMS fails to mention that capitation payments can also lead to providing less care that is desirable.

Ask yourself, how does an insurance plan affect health outcomes? How does it determine the quality of care provided or the level of patient compliance with treatment requirements?

What basic healthcare services coverage is not already standardized? Medicare Advantage (MA) plans are required to cover everything that Original Medicare (Part A and Part B) covers. They may provide extra benefit like some dental and vision, but they are not significant.

It seems to me this is a plan that will drive people out of Medicare Advantage that was supposed to save Medicare money, but it seems nobody asked how.

Here are three of the strategies:

1. Pilot Multiyear Enrollment in Plans. MA plans looking to make investments in prevention and effective treatment face a conundrum: people under our care drop out of our plans on an annual basis. One way to fix this is to move away from annual enrollment and create options for people to enroll in plans for several years at a time. Dr. Oz has called for “shifting the paradigm for health care from a system that focuses on sick care to one that fosters prevention, wellness, and chronic disease management.” Multiyear enrollment would provide the necessary incentives to achieve this worthy goal because you can’t really invest in improving health in 1-year increments.

2. Standardize Plan Benefits. Plans should be competing based on excellence and their proven abilities to drive outcomes, not edge benefits and giveaways like cash rebates. By adopting standardized plan benefits and requiring them to address genuine health needs, CMS could ensure that when consumers choose plans on the basis of plan quality and health outcomes—which should be the most important metric in their decision-making process.

5. Incentivize Integration Between Health Plans and Provider Organizations. There’s a lot of friction in our healthcare system, especially between health plans and provider organizations. Plans allege providers drive up costs with unnecessary procedures, tests and prescription medications; providers say plans are inflexible and stand in the way of appropriate patient care.

It’s beyond time to change the dynamic between these two groups. Many have already discovered that the best way to do this is to enter into global capitation arrangements by which providers receive a fee to manage all of a plan member’s healthcare expenses. The benefit of these arrangements is that they encourage each group to focus on what they do best: payers manage risk while providers make decisions about direct care. The best of these arrangements are true partnerships in which payers and providers transparently design products together that play to both groups’ strengths with an orientation toward improving outcomes. Going forward, it would be in patients’ interests for CMS to offer a standardized framework for payers and providers to collaborate in this way.