AMGA Endorses Medicare Advantage Changes

Reiterates Concerns on Overuse of Prior Authorization

Alexandria, VA - AMGA today endorsed a number of Medicare Advantage proposals intended to expand beneficiary use of supplemental benefits. AMGA strongly supports the Centers for Medicare & Medicaid Services’ (CMS) effort to transition the Medicare population to value-based care by 2030. Medicare Advantage will play a significant role in achieving this goal, and AMGA believes the proposed technical changes to the program will continue to strengthen it.  

In a letter to the agency, AMGA stated we are pleased the rule recognizes the importance of supplemental benefits for chronically ill beneficiaries and would simplify the process to include such benefits in Medicare Advantage plans. AMGA also agrees with the proposed changes designed to ensure plans market the availability of the supplemental benefits to patients.  

“Addressing the holistic needs of chronically ill patients, including social drivers that influence health outcomes, is critical to their overall well-being,” said AMGA President and CEO Jerry Penso, MD, MBA. “Ensuring patients are aware of what services are available will help them get the most out of their coverage and benefits.”    

AMGA also recommended reforms to prior authorization policies. The proposed rule would require plans to consider the health equity effects of any prior authorization policies and procedures. AMGA appreciates the emphasis on disparities, but reiterates our concerns that prior authorization often creates significant barriers to care, particularly for underserved populations. AMGA recommends that rather than reforming internal plan operations, prior authorization be used less frequently and that plans expedite approvals. 

The letter is available on the AMGA website. 

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About AMGA

AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. 

AMGA represents medical groups and integrated systems of care. Its diverse membership includes multispecialty medical groups, integrated delivery systems, accountable care organizations, and other entities committed to improving healthcare outcomes. AMGA advocates for the formation of innovative, clinically integrated systems of care that advance population health, enhance patient experience, and reduce healthcare costs. For more information, please visit www.amga.org.