Alternative Payment Models in Cancer Care-2021 Medicare Advantages and Medicaid Managed Care Updates: Where Are We Headed?

Video Transcription

Video Summary

This webinar from ACCC and Avalere Health reviewed how Medicare Advantage (MA) and managed Medicaid are changing in 2021, with a focus on implications for oncology practices. Speakers explained that Medicare Advantage enrollment has grown rapidly, now covering about 38% of Medicare beneficiaries, driven by zero-premium plans, supplemental benefits, and increasing familiarity with managed care. However, they noted that MA can create challenges for cancer patients and practices, including network restrictions, high out-of-pocket costs, and added administrative burden.<br /><br />The discussion highlighted that MA plans are increasingly using value-based care and alternative payment models, including shared savings, pay-for-performance, and capitated arrangements. In oncology, these models often resemble the Oncology Care Model, though many single-specialty practices still operate under traditional fee-for-service contracts. Medicaid managed care was described as widespread but generally less advanced in oncology-specific alternative payment models, though some states are expanding value-based payment requirements.<br /><br />A major portion of the webinar focused on MA economics, especially risk adjustment and star ratings. Speakers explained how diagnosis coding affects risk scores, plan payments, and rebates that help fund zero-premium plans and supplemental benefits. They also emphasized that star ratings strongly influence plan revenue and beneficiary choice, making quality and patient experience critical.<br /><br />The webinar concluded with practical advice for practices: understand plan mechanics, demand timely claims and clinical data, assess plan size and market presence, and use performance data to negotiate win-win arrangements that improve care quality and financial outcomes.

Keywords

Medicare Advantage

managed Medicaid

oncology practices

value-based care

alternative payment models

risk adjustment

star ratings

diagnosis coding

network restrictions

claims data