Medicare’s Changing Priorities Open Opportunities for the Industry

Insights on senior housing and care from the agency’s top administrator.  

More data. More dialogue. That was the ask of the industry by the director of the Medicare program during a candid discussion at the 2024 NIC Spring Conference in Dallas.

“We all have to partner together to provide better care, improve population health and spend the healthcare dollar in a more effective way,” said Dr. Meena Seshamani, MD, PhD, Deputy Administrator and Director of the Center for Medicare. “I want to drive everyone to a call to action.” 

In a lively Q&A format, the well-attended, keynote session addressed the direction of the Medicare program and what it means for senior housing and care, dovetailing with the conference theme “Insights into Action.” The discussion was facilitated by David C. Grabowski, PhD, Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School.  

Attendees got an insider’s look at Medicare’s priorities. Top of the list is the shift to value-based care arrangements. All Medicare beneficiaries are expected to be treated by a provider in a value-based care model by 2030, according to the Centers for Medicare and Medicaid Services (CMS). Seshamani explained that value-based care is an effort to rethink how healthcare is provided. Instead of treating illnesses on a fee-for-service basis, value-based care models treat the whole person with the aim of keeping them healthy to ultimately drive better outcomes at a lower cost. 

“Can senior living be part of holistic care?” asked Grabowski. “Is there an opportunity to provide care on site?” 

“Yes,” said Seshamani, adding that there is an opportunity to provide people with care where they live. But she noted that senior living is not considered a provider under the Medicare law. “That is where partnerships that are data-driven to demonstrate quality and cost, can enable what we all seek to provide. That is where the power of value-based care comes into play,” she said.  

Possible partners for senior living providers are Accountable Care Organizations (ACOs) and Medicare Advantage plans, both value-based care models.  

ACOs, for example, take responsibility for the cost and quality of care provided to patients. If an ACO meets quality metrics and saves Medicare money, then the ACO shares in the savings. “ACOs have knocked it out of the park on quality measures,” said Seshamani. “It’s an example of how partnerships can work to everyone’s benefit.” 

CMS recently issued a request for comment on Medicare Advantage plans to gauge the effectiveness of the model. Seshamani challenged the audience to submit their ideas by the end of May.  

“We need data and transparency to encourage innovation and market competition in ways that are central to our mission,” she said.  

Measure Results 

Grabowski asked what metrics senior living providers should track.  

CMS has created a universal foundation of quality metrics that can drive change.  

Measures include tests such as screening for depression, blood pressure, and diabetes, among others. CMS also has an innovation center to test new program models and metrics.  

Medicare doesn’t cover long-term care, but Grabowski wondered about Medicare Advantage plans that offer a supplemental benefit for long-term care.  

Seshamani said this is another case where CMS needs more data to assess the effectiveness of the benefit. Do people understand the benefit? What is the uptake? Does it improve health? Medicare Advantage plans have been asked to report their data. “We want to make sure that what is being offered is being delivered,” she said.  

Grabowski observed that prior authorizations and denials of care required by Medicare Advantage plans are common pain points for skilled nursing providers. In an example of how dialogue with stakeholders can impact policy, CMS asked for comments on the issue and received 4,000 replies. The feedback was used to change the policies. For example, as of January 1, 2024, denials can only be made by providers with clinical expertise.  

NIC Co-founder and Strategic Advisor Bob Kramer fielded audience questions in an animated back and forth.  

Question: What about staffing shortages? 

Seshamani: Providers are encouraged to look for partnerships. For example, Medicare pays for certain community health services. 

Question: How can senior living providers partner with Medicare Advantage plans for non-medical services? 

Seshamani: Medicare wants more information on the kinds of benefits that are working. Providing data is a good way to engage with Medicare.   

Kramer wrapped up the session emphasizing that the senior living sector has an enormous opportunity. Providers have their eyes on Medicare beneficiaries 24/7. 

“Dr. Seshamani is here to spur a dialogue,” said Kramer. He added that as senior living moves to center stage on quality-of-life issues for older people, the industry must provide data. “We can’t just say we do a great job,” said Kramer. “Dr. Seshamani has opened the door for us to show our results.” 

Conference attendees can view the entire session with Dr. Seshamani on the conference app.