During a House Ways and Means Committee hearing before the Congressional recess, Rep. Adrian Smith (R-NE) asked Vice President of Clinical Quality and Population Health Officer at Avera Health Dr. David A. Basel, M.D. about the success of some health agencies in rural areas.
00:00I guess we now move two-to-one questioning. I recognize Mr. Smith, Nebraska.
00:06Thank you, Mr. Chairman. Thank you to our entire panel for participating in what I think is a very timely discussion.
00:12Something that I think should be on all of our minds.
00:16And looking at, you know, Medicare Advantage has been around for some time now, and I think we have a lot of data to draw on.
00:23I think hearing from seniors, many of whom appreciate being on a Medicare Advantage, I think we ought to pay attention to that.
00:34But also look a little deeper than that and make sure that we are formulating policy that is good for seniors, good for their health care, and certainly good for our country.
00:46And so I think there's some things we can take away, and the flexibility and creativity, if you will, that some plans offer that actually contribute to better health.
00:56That, as Ms. Maroney was speaking about, I think we need to be mindful of that.
01:02I represent one of the most rural districts in a very rural state, and so there's not as much participation, as you know,
01:10not as many options that would exist for patients across my district.
01:16And I want to make sure that seniors have the choices that can lead to higher quality outcomes and cost savings as well.
01:27I hear from providers that are concerned about additional paperwork.
01:32That leads to cost, obviously.
01:36Now, in all honesty, there are a lot of, there are some providers who are saying they don't want to participate at all,
01:42and that should get our attention in a hurry.
01:46And when the beauty of the system should be a plan in discussion with providers can come up with a good solve for a patient,
01:58so that that's what we want.
02:00And so when perhaps a provider feels shut out, I think that that should be addressed.
02:06But, Dr. Basel, I certainly appreciate the services that are offered by Avera in my district,
02:13and I know that Avera is involved both on the hospital side and in the MA plan equation.
02:21I know you're very familiar.
02:23And how would you say Avera has operated differently than other MA plans in order to succeed in rural areas
02:29where other plans have actually encountered challenges?
02:33Thank you, Representative Smith.
02:35And, you know, earlier I talked about, you know, the transportation issues in many of our rural areas.
02:39You know, one of the facilities in your areas in O'Neill, Nebraska, is one of those places where we've worked with
02:43coming up with a transportation system of our own.
02:47But in general, you know, prevention, we talked about, is one of the key things that certainly plays into here.
02:53But coordination of care is the other thing.
02:54And that's where I think Avera has an advantage being both a health care system as well as the payer there
02:59because we can do that care coordination, reduce that fragmentation of care,
03:04and then shift towards the prevention side.
03:07And so, you know, it's all about that alignment of incentives.
03:11You talked earlier about why don't we do more prevention.
03:14And it's about that alignment and that time horizon.
03:17You know, prevention is going to save us money 10 years, 20 years down the road.
03:21And so how do you get to the short-term thing so that you can reinvest it in that prevention
03:25that's going to save you money on down the road?
03:28Okay.
03:28Where could you say CMS could take steps to ensure that rural seniors continue to have access to high-quality MA options?
03:38So you think about network sufficiency as one of our biggest problems in getting access to MA plans,
03:44certainly in a lot of your constituents,
03:47because they're so rural at being able to get specialty care within the guidelines.
03:51And so that's something that you've worked on in the past to, you know, network adequacy problems.
03:57That continues to be something that we look to partner with, you know,
03:59some of the changes in telemedicine to allow us to do a little bit more in those areas.
04:04But also it gets to some of those coding intensity changes too.
04:08That's a have and have-nots.
04:10And so if you've got certain MA plans that are very aggressive about coding intensity,
04:16you know, ones like us that take more of a clinical approach too,
04:19if you're not managing that disease clinically, then it shouldn't be, you know, on that chart.
04:24You know, we get hurt by those across-the-board coding intensity reductions.
04:29And so trying to go after only those that have the more aggressive tendencies
04:34as opposed to putting across-the-board reductions would be very helpful to smaller plans like ours.
04:40Okay. All right.
04:41Well, I appreciate your perspective.
04:43And certainly it's been mentioned already what some of the good parts are, what the challenges are.
04:48I'm very concerned about straight-up fraud that takes place that I would hope we have the tools necessary to address that,
04:57realizing there are some good parts of this that we don't want to lose as we sort things out.
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