00:00And I'll recognize Chairman Smith for questions.
00:03Thank you, Chairman Buchanan.
00:05When 54% of the Medicare beneficiaries are choosing a Medicare Advantage plan,
00:11there is clearly a strong and growing interest by seniors to have access to MA and the benefits that come with it,
00:20like lower out-of-pocket costs, access to supplemental benefits such as prescription drug coverage and transportation services,
00:27as well as specialized plans tailored to patients with chronic conditions.
00:33Patient enthusiasm for the program is exactly why we should ensure its integrity.
00:41For example, we know of concerns about MA plans inflating a patient's level of sickness,
00:50resulting in higher reimbursements for the plan at taxpayer expense,
00:56and an estimated $40 billion in 2025 alone.
01:03Ms. Maroney, how rampant of an issue is this?
01:08And what can Congress do to help support the Trump administration protecting this program
01:14so treatment is given where it is needed?
01:19Excellent question.
01:21You know, full transparency, making sure that organizations,
01:26if there is abuse that's going on at an individual organizational level,
01:30that that organization is being held accountable.
01:34You know, seniors in today's environment, they utilize these programs because they are of value.
01:41There's an additional $200 per member per month in benefits that are available and accessible to these individuals,
01:47which equates to close to $2,500 or $2,400 a year.
01:52And then when you think about if they had to go on Medicare fee-for-service on its own,
01:57and they're selecting a fee-for-service program,
02:00then that program is anywhere from $200 to $300 per member per month,
02:05in addition to just to get the full comprehension of the program as a whole.
02:09I do believe that there is reform that is required.
02:13There's opportunity.
02:14There's opportunity for us all to sit at the table and to come up with a collaborative dialogue
02:18to make sure that how do we have full transparency and perfection to improve the program
02:24but not take away from the program,
02:26and to make sure that the individuals that I've talked about,
02:29that they're still getting the value of that benefit on a monthly basis,
02:33in addition not having to pay hundreds of dollars of premiums.
02:37when many individuals who are enrolled in these programs are on very fixed incomes.
02:44So one of the well-known benefits of engaging the private sector is the faster pace of innovation,
02:52which in the case of health care means a system that can respond more quickly
02:57to the needs of patients and providers.
03:00My number one priority when it comes to health care reform
03:03is expanding access to higher-quality care in rural communities.
03:10Dr. Bezel, we have seen rapid growth of MA in rural areas in recent years.
03:17What are some of the main lessons you've learned from your experience serving rural communities,
03:23and how should MA incorporate those lessons to enhance access
03:29and deliver better health outcomes for rural patients?
03:33Thank you, Chairman.
03:35So one of the potential benefits of being an MA plant is that innovation
03:40and that flexibility to be able to respond to the needs.
03:43Especially in our rural areas, our community health needs assessments
03:46that the hospitals do every couple of years,
03:49transportation is a good example of something that comes up in the top two or three needs
03:54in those assessments in every one of our communities.
03:57Especially in our rural areas, you know, there are not such things as ride-sharing programs
04:02or even taxi services.
04:03And a lot of times our hospitals are where that ends up taking on both the medical transportation
04:10but even the non-medical transportation.
04:11Getting someone to social activities, loneliness, social isolation is one of the biggest predictors
04:17of adverse health in the elderly.
04:19And so that's a good example of where it's worth it to us, you know,
04:23to look at that transportation and to bear some of the cost of developing those programs,
04:28even though that's not a traditional health care expense.
04:30And so it's that type of innovation that the promise of MA hopefully can deliver on.
04:36In addition to the upcoding issues we have heard about, the MA plan's excessive pre-approvals
04:43can get in the way of timely care for patients and layer on additional paperwork for providers.
04:51In our rural communities, 80% of providers say utilization management creates administrative burdens.
05:00Dr. Miller, can you shed some light on how practices like excessive prior authorization have become a growing problem
05:09and what can be done to improve care for patients and reduce burdens on providers
05:15while still maintaining the goal of a more efficient, lower-cost health care system?
05:21I think everyone has a stake in this one.
05:24First of all, it should be one-click submission of data in the electronic health record.
05:30The patient's seeing you, you shouldn't get a request weeks or months later.
05:33It should be real-time.
05:34You submit your data, it automatically reports labs, notes, imaging studies.
05:39You should be able to access what the medical criteria are.
05:43For outpatient prescription drugs, for example, you should know whether it's non-formulary, tier 1, tier 2, tier 3.
05:50So pushing that information to the point of care is something that CMS and plans can do together.
05:57I think on the provider's side, we need to improve our documentation enormously.
06:02So a lot of denials are because you don't have the right information, you don't have the member number,
06:07you don't have the date of birth.
06:09The note is copy-forwarded for every single day of the 24-day hospitalization
06:14and says the exact same thing with no additions.
06:17A lot of tools that we can do to support doctors and hospitals with documentation,
06:22the ambient AI scribes, the voice dictation,
06:26I think a lot of those things that will happen over the next five years
06:29from both the hospital industry, the plant industry, and CMS as a regulator
06:33can actually solve a lot of these problems.
06:36It's very fixable.
06:38Thank you, Chairman Buchanan, Chairman Schweikert.
06:40I yield back.
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