Welcome Ryan Long + New Medicare Brief

I am so excited to start today’s newsletter by announcing that Ryan Long, who served as health policy advisor to then-Speaker of the House Kevin McCarthy as part of a distinguished health policy career, has joined Paragon. I also discuss an important new policy brief by Paragon senior policy analyst Joe Albanese on Medicare Advantage, Accountability Care Organizations (ACOs), and the future of Medicare, as well as a Paragon Pic showing Medicare’s payment rates by system over the past decade.

Paragon’s New Director of Congressional Relations and Sr. Research Fellow

Monday, January 13th, marked the first day for Ryan Long, Paragon’s newest team member. Ryan joins Paragon as Director of Congressional Relations & Senior Research Fellow, and he brings Paragon over 25 years of experience on the Hill and in health policy.

At Paragon, Ryan will take a leading role in communicating Paragon’s research and proposals to Congress. He will be instrumental in connecting with and educating policymakers and their staffs and will lead our Congressional Health Policy Education Program. As a researcher, Ryan will produce original papers and policy briefs promoting consumer choice, market competition, and innovation in healthcare markets. These publications will focus on regulatory and policy reforms to ensure a sustainable and innovative health care system.

Ryan began his career working under Representatives Charlie Norwood of Georgia and Joe Barton of Texas before joining the House Committee on Energy and Commerce in 2004, where he eventually became Chief Health Counsel. In 2018, Long became Deputy Staff Director then Staff Director under E&C Chair Greg Walden, and by 2021 he had become a top advisor to the eventual Speaker of the House.

We thank former Speaker Kevin McCarthy for providing the following comment about this development: “Paragon and Ryan are the right fit at the right time. From his work at the Energy and Commerce Committee to his role as my senior policy advisor and counsel, Ryan has dedicated his career to developing conservative health care policy and understanding the process to effectuate change. He was critical to our majority in the House and will do great things at Paragon.”

MA, ACOs, and the Future of Medicare

This morning, we have a new policy brief from Joe Albanese digging into the design differences – and common policy issues – between Medicare Advantage (MA) and Accountable Care Organizations (ACOs).

On the surface, there is little overlap between these two. MA (also called Part C) is a program where seniors can elect to get their Medicare coverage from an insurance plan rather than the government. On the other hand, ACOs are groups of health care providers that earn “shared savings” (or losses) within specific models, particularly the Medicare Shared Savings Program, based on their ability to manage the health care costs of traditional Medicare enrollees. There are also numerous differences in the rules they each face – for example, Medicare beneficiaries enroll in MA plans but are assigned to ACOs based on their primary care provider, which puts pressure on MA plans to compete for enrollees based on the value of coverage they offer.

However, both models of health care delivery have emerged as the main alternatives to traditional Medicare’s antiquated fee-for-service model because they require health care entities to take on financial risk for the cost and quality of their beneficiary populations. They also have many common policy issues: researchers have raised concerns with their payment benchmarks, risk adjustment methods, quality measurement requirements, and selection biases. These questions directly impact their potential to improve Medicare’s finances and health outcomes.

Joe has previously written at length about the potential for MA in particular to transform the Medicare program by embracing market competition and enrollee choice between coverage options. This new brief can serve as an additional resource for health policy experts who want to understand the issues with both MA and ACOs and consider ways to move beyond Medicare’s outdated structure.

Paragon Pic

The start of 2025 means that Medicare’s new payment rates, finalized in regulations during the previous year, have officially taken effect. These updates are usually quite technical, but they set the stage for some of the biggest policy fights in the new Congress. This week’s Paragon Pic (above), derived from a recent Paragon Prognosis post, “Money Changes Everything,” displays the cumulative changes in Medicare payment rates for select providers since 2016.

As the figure shows, the clear outlier has been physician rates. Since the enactment of the Medicare Access and CHIP Reauthorization Act of 2015, they have seen several years of Medicare payment rate reductions that have led to a cumulative 10 percent decline over the past decade. Congress usually steps in to mitigate the cuts with a “Doc Fix,” but that hasn’t happened yet for 2025.

Meanwhile, the big winners have been hospitals and post-acute care facilities – on average, payment rates for these providers have gone up by 25 percent in the last 10 years. The health care system, unsurprisingly, embraces these financial incentives. For example, Medicare payment policies are a major reason why health care providers are consolidating within hospital systems. For this reason, there have been numerous proposals to control hospital and post-acute care spending, especially by using site neutrality policies to equalize rates across sites of service.

All the best,

Brian Blase
President
Paragon Health Institute