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IMPROVE PROGRAM MANAGEMENT FOR
EFFICIENCY AND BETTER SERVICE TO BENEFICIARIES
Evidence:
United States. Government Accountability Office. "Medicare: High Risk Issue." 30 Nov 2018
CMS is responsible for overseeing the MA program, including assessing whether an MA plan’s provider network is adequate. To improve these oversight activities, CMS should augment oversight of MA networks to address provider availability, verify provider information submitted by MA organizations, conduct more periodic reviews of network information, and set minimum information requirements for MA enrollee notification letters. Another concern within certain MA plans is that beneficiaries with poorer health tend to dis-enroll from (that is, voluntarily leave) certain plans at disproportionate rates. CMS should improve oversight of the program by using data on the health status of people who leave Medicare Advantage contracts and the reasons they give for leaving.
To achieve Medicare savings for durable medical equipment, Congress required that CMS implement a competitive bidding program for equipment suppliers. The program has generated savings for Medicare and available evidence indicates no widespread effects on beneficiary access to equipment. Continued monitoring of the competitive bidding program experience is important to determine the full effects it may have on Medicare beneficiaries and equipment suppliers. For example, CMS could evaluate the potential costs and savings of using disposable devices as substitutes for durable ones.