Revolutionizing Healthcare: Medicare Advantage’s Latest Strategic Move

Medicare Advantage plans have been a source of frustration for health systems, as they continue to face delays and denials in coverage. This has led to some systems opting to drop contracts with the private plans. Despite these challenges, enrollment in Medicare Advantage is on the rise, with insurers seeing opportunity as more people become eligible for Medicare.

According to KFF, Medicare Advantage enrollment increased by 8%, or 2.3 million beneficiaries, in the last year alone. Some health systems, like UNC Health, are finding it difficult to work with Medicare Advantage plans that are denying care to boost their earnings. This has led to the development of partnerships with more reliable payers and a potential contraction with Medicare Advantage plans that are not good partners.

Will Bryant, CFO of UNC Health, expressed during a panel at the Becker’s 11th CEO+CFO Roundtable that health systems need better communication and partnerships with payers to develop mutually beneficial solutions without interference from CMS or others. He hopes that future payer-provider partnerships will help solve the problems that have arisen over the past 30-plus years.

In response to these challenges, CMS is proposing more regulations to address the issue. These include prohibiting volume-based bonuses for third-party marketing organizations and requiring health plans to provide a mid-year notice for enrollees about any supplemental benefits changes made. The goal is that these regulations will lead to better communication and partnership between health systems and Medicare Advantage plans.