Medicare Advantage has become the dominant way older Americans receive healthcare, but the program still lacks one key ingredient: a long-term commitment.
In two decades, Medicare Advantage has more than quadrupled enrollment to surpass traditional Medicare. Today one of every 10 Americans is on a Medicare Advantage plan, which provides consumers with all-in-one coverage with lower predictable costs and benefits for prescription drugs, vision, dental, hearing, and wellness.
To promote competition in the marketplace, consumers are offered the chance to change Medicare Advantage programs each year. But short-term commitments from customers make it much harder for medical providers to plan to serve them – annual churn rates have increased to 20 percent or more per year, with half of all customers changing plans at least once every five years.
High customer turnover increases pressure on medical providers to focus on short-term financial gains. One result is that news coverage of Medicare Advantage lately has been full of stories about billing abuses and aggressive upcoding to inflate reimbursements.
Despite these systemic failures, the core philosophy of Medicare Advantage is worth saving. The problem isn’t the intent – it’s the timeline. To truly deliver on the promise of proactive, preventive care for seniors with complex, chronic conditions, we should move away from the current one-year open enrollment cycle and toward a five-year contract period.
In the current landscape, insurance companies and providers are trapped in a revolving door. Because seniors can change their plans every year during open enrollment, the entire system is incentivized toward short-term thinking.
Insurers are hesitant to invest in long-term wellness or social determinants of health—like addressing senior loneliness, depression, or food insecurity—because they may lose that member to a competitor before they ever see a return on that investment. Some modern medical therapies require more than a year to show significant results, but there’s no financial incentive for providers to offer them without assurance that the customer will remain to reap the health benefits.
When we treat healthcare like a one-year subscription service, we fail to account for the biological reality of aging. For a 75-year-old with multiple chronic conditions, health isn’t a straight line. It’s a variable trajectory. A one-year snippet of care isn’t enough to build the trust necessary to influence that trajectory. Too many seniors are being treated as data points to be reconciled annually rather than human beings in need of a life plan.
At the heart of successful medicine is the relationship between the consumer and their primary care physician. In our current system, the typical 15-minute doctor’s appointment for a senior is a joke. It’s barely enough time to address five or six different health symptoms, let alone understand the life factors that drive those symptoms.
A five-year contract would change the math of the doctor-consumer relationship. It takes at least a year just to build trust with a frail senior and understand what actually happened in their last decade in the acute care system. It takes time to de-prescribe unnecessary medications, clean up fragmented care plans, and determine a patient’s actual life goals.
Does a 75-year-old truly want an aggressive heart valve replacement, or would they prefer a palliative route that prioritizes quality of life at home? It’s hard to answer that in a one-year enrollment period that has little time for trust or understanding. You need a multi-year horizon to build a life plan that staves off hospitalizations and breaks the cycle of health crises.
The current one-year model rewards symptom management. If a provider solves a symptom, they get paid. But no one has incentive to find the root cause.
Consider the all-too-common story of a senior who falls and breaks a hip. The system is great at fixing the hip – we can see the bone on an X-ray and pay for the surgery. But no one asks why the person fell. Maybe the root cause is loneliness—they stopped eating, grew weak, and missed their medications. Fixing the hip without fixing the reasons behind the broken hip ensures they will be back in the hospital within months.
By locking in a five-year commitment, providers would have a runway to spend money upfront on proactive care. In a five-year model, an insurer or a provider group can afford to spend more in years one and two to stabilize a senior’s social and medical environment, knowing they will produce a healthier, lower-cost senior in years four and five.
Currently, if a provider does that heavy lifting in year one, a competitor can move in and take the savings in year two. That is a recipe for rewarding poor performance and punishing innovation.
It’s true that some unscrupulous providers could view a five-year commitment as a license to take for granted their locked-in customers. That’s why it makes sense to grant early opt-outs to consumers who experience truly bad service. The overall point, though, is to build an expectation for both providers and consumers to invest in a trusting relationship. Less money and time spent on annual marketing to retain existing customers means more resources can be devoted to actual medical care.
True choice for a senior isn’t the ability to swap insurance cards every December. It’s the choice to have a consistent team that knows them as a person, not as a collection of ailments.
We have pediatricians who stay with children from birth to age 18, providing decades of continuity. It’s shortsighted to settle for less as we grow older.
Photo: zimmytws, Getty Images
Joel Theisen RN, BSN is chief executive and founder of Lifespark, an industry leading COMPLETE Senior Health company based in Minnesota. He is passionate about empowering all seniors to Age Magnificently!
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