This is a new column we are launching, where we pose a question or share a perspective or prediction about some aspect of the health insurance/finance industry. We invite industry leaders aka influencers to weigh in. When we receive responses worthy of readers attention, we will share. If you would like to participate, reach out to email@example.com.
PREDICTION: Medicare Advantage Will Remain Under A Microscope
By Sachin H. Jain, Forbes, Dec. 2022
I predicted last year that the Medicare Advantage debate would intensify.
The year 2022 didn’t disappoint as the pages of the Health Affairs blog were sent out to numerous Medicare Advantage defenders including heavyweights WellBe Medical CEO Jeff Kang, former Kaiser Permanente CEO George Halvorson, and former CAPG CEO Don Crane. New York Times writers Reed Abelson and Margot Sanger Katz followed on with a provocative set of articles on Medicare Advantage utilization management practices; revenue capture; and broker practices.
The microscope is turned on and examining Medicare Advantage in high resolution—and this scrutiny will continue deep into 2023.
As the CEO of Medicare Advantage plans for 7 years running, I have strong conviction that the Medicare Advantage is an important program that enables innovation to serve older adults, but also acknowledge that there is significant room to improve it.
To address some of the emerging skepticism of Medicare Advantage, plans should
- proactively implement more stringent revenue coding practices
- commit to access-to-care “never events” to ensure beneficiaries always have access to care in a timely manner
- continue to enhance the quality of benefits delivered through their products.
Dawn Maroney shares her perspective
By Dawn Maroney, CEO of Alignment Health Plan and president, Markets of Alignment Health
Q: Do you agree or disagree on the specific points from Forbes?
Medicare Advantage (MA) has always been under a microscope, and it is no different this year. MA is more popular than ever and will continue to be an attractive choice for Medicare-eligible individuals. Its growth and success are what is getting the attention. For years, we have seen new entrants into the business who falter because they do not have the passion or focus on serving or caring for seniors — this is what is getting attention, not MA.
Q: Are there other Medicare trends you feel are trending and want to comment on?
As someone who has been working in Medicare for more than 30 years, it’s evident to me that we need to correct bad behavior within the market, and it needs to apply across the board. For example, if an agency is terminated for bad practices by one plan, often the agency will contract with another plan and encourage members to move to the new plan, which may not be in the best interests of the members.