Aspirion ’s Post

What's does the future of Medicare Advantage look like? This in-depth article from McKinsey & Company explores considerations for payers and how they may respond. #valuebasedcare #MedicareAdvantage #healthcare

The AHA released an interesting infographic related to Medicare reimbursement, which shows that Medicare payment rates hit an all-time low compared to costs in 2022. Health systems will need to look to more drastically subsidize through other payment mechanisms (i.e., commercial, alternative payment models, etc.), or further diversify their revenue streams: https://buff.ly/3ud5uzs #WhitecapTrendsFinance

The 2024 March Healthcare Classic runner-up, Evolution of Medicare Advantage (1), is making headlines as predicted by our Selection Committee.   As MA heads into its annual enrollment period this October, beneficiaries are facing increased challenges and strains caused by the evolving market. With increased regulations from CMS, smaller base payments, and rising healthcare costs, the enrollment process will be more complicated. Adding to the complexities, the presidential election and the late Thanksgiving holiday may delay decision-making until the final week, causing additional stress for enrollees.    Our three things that matter:    1. Regulatory and financial pressures are causing major shifts in the MA market. In June, the Office of Inspector General (OIG) announced its intentions to audit MA plans; many were accused of denying post-acute care even in instances where beneficiaries qualified for such healthcare services. With increased scrutiny from the government and rising healthcare costs, MA plans are eliminating certain benefits while exiting less profitable markets. Earlier this week, Humana announced it would exit 13 MA markets. Meanwhile, CVS Health has also downgraded its geographic presence—potentially poised to lose up to 10% of its current MA members. 2. Following increased pressure, tensions are rising between MA plans and the government. The industry is undertaking a seven-figure lobbying campaign to advocate for the importance of MA. This includes digital ads, social media campaigns, and encouraging older adults to share their positive MA experiences with policymakers. While this is not a new tactic, it remains to be seen whether it will counter negative press including fraud allegations and prior authorization denials.  3. As competition increases, MA plans will need to appeal to beneficiaries’ needs amidst these changes. Not surprisingly, beneficiaries will prioritize stability in benefits when choosing a plan. To stand out, MA plans need to offer exceptional service quality and prioritize effectiveness. Despite downsizing their market presence, a strong emphasis on quality and comprehensive offerings will be crucial for attracting and keeping members.   How can MA plans effectively balance reduced market access and the elimination of benefits with the need to maintain high-quality offerings for beneficiaries? What strategies should be implemented to address these challenges? Sources: Becker's Healthcare and Healthcare Dive #ro3llc #Healthcare #MedicareAdvantage #MA #MAPlans #Enrollment

Ahead of our six-month recap for the 2024 March Healthcare Classic, we are sharing an analysis of the evolving Medicare Advantage landscape. This year’s runner-up, Evolution of Medicare Advantage (1) is at the forefront of conversations, further validating the Selection Committee’s decision to include it in the Top Four.    Many shifts in the market will potentially contribute to major changes in the MA market. With increased scrutiny from the government, MA plans are being audited for various issues including fraud allegations and prior authorization denials. The industry’s response to these pressures is twofold. First, many big players—including Humana and CVS Health—are prioritizing profit margins and pulling back their geographic presence, reducing their MA members. Additionally, the industry is launching a 7-figure lobbying campaign in an attempt to safeguard MA.    However, with all these shifts, beneficiaries hold significant decision-making power, adding an interesting dynamic to the future of MA. As plans cut back their geographic presence, they will need to re-prioritize effectiveness, quality, and comprehensive offerings to attract and keep members.    Read our full analysis below and share your thoughts in the comments. How can MA plans effectively balance reduced market access and the elimination of benefits with the need to maintain high-quality offerings for beneficiaries? What strategies should be implemented to address these challenges?   Stay tuned for our six-month recap, which will be published in early October! #ro3llc #Healthcare #MedicareAdvantage #MA #MAPlans #Enrollment

It is Monday, June 17th, 2024! Good Afternoon, MABillers! MA enrollees save over $2,500 annually on health costs. A report from ATI Advisory showed older adults covered by Medicare Advantage plans spent an average of $2,541 less on health care costs per year than their counterparts in traditional Medicare in 2021. The analysis, based on Medicare beneficiary data from 2019 to 2021, showed average total health care costs increased 24% for MA enrollees and 15% for fee-for-service Medicare members from 2020 to 2021. Low-income Medicare enrollees were more likely to experience cost burden than their MA counterparts. https://lnkd.in/etYGJy6W #MAB #CMBS #CPSP #MARA #MedicalBilling #Medical #Billing #Reimbursement #Credentials #Training #RemoteWork #Remote

The article discusses the growing prominence of Medicare Advantage (MA) plans in the U.S. healthcare system, emphasizing trends like enrollment growth, benefit expansion, and heightened competition among insurers. It underscores the importance of innovation in MA plans to address healthcare challenges, improve member experiences, and outlines strategies for insurers to thrive in this evolving market. https://rb.gy/83hrhn Here at CareAdvisors, we have a passion for sharing the latest news on trending topics in healthcare. #healthcaretrends #medicareadvantage #healthcaretechnology

Hospitals are increasingly frustrated with the Medicare Advantage (MA) program, as insurers delay payments and impose administrative hurdles. This affects hospitals' ability to provide high-quality care while grappling with prior authorizations and denied claims. With over 33.8 million beneficiaries in MA, insurers prioritize margins, exacerbating the financial strain on hospitals, especially when compared to traditional Medicare. S&P Global warns that future cuts to MA could further harm hospitals, leading many providers to withdraw from MA programs, as seen with Carson Tahoe Health. UnitedHealthcare has been particularly criticized, with hospitals like Duke University Health System and Trinity Health reporting significant issues with denials and payment delays. Duke, for example, employs 236 staff to address denials, overturning 97% of them after extended efforts. While some health systems, such as Trinity, have reached agreements with payers, the ongoing challenges highlight the need for fairer payment practices and better collaboration between providers and insurers. Our RCM team helps hospitals navigate Medicare Advantage challenges by streamlining processes for prior authorizations, addressing payment delays, and managing denials. We focus on root cause analysis, optimizing reimbursement, and improving contract negotiations, ensuring providers maintain financial stability while delivering high-quality care despite administrative burdens. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare

16 health systems dropping Medicare Advantage plans | 2024 More health systems should decide to stop being in network with the worst Medicare Advantage offenders who play games in paying claims timely, denying medically necessary care, paying a claim, and then hiring these bottom feeders like Cotivit, Exel, Gainwell, and many other "cost containment" companies to steal back money after authorization for inpatient care has been given in the first place. How about Cotiviti making up and bending coding rules to deny appropriate compliant coding? It is time to take collective action and a stance against these for-profit Medicare Advantage plans that put profits before patient care—record profits for these plans at the expense of the providers and Medicare beneficiaries. #Medicareadvntage, #takeastandagainstMedicareadvantage, #greedyforprofitMedicareadvantageplans https://lnkd.in/eZwfWKw3

MA enrollees save over $2,500 annually on health costs A report from ATI Advisory showed older adults covered by Medicare Advantage plans spent an average of $2,541 less on health care costs per year than their counterparts in traditional Medicare in 2021. The analysis, based on Medicare beneficiary data from 2019 to 2021, showed average total health care costs increased 24% for MA enrollees and 15% for fee-for-service Medicare members from 2020 to 2021. Low-income Medicare enrollees were more likely to experience cost burden than their MA counterparts. https://lnkd.in/eTHjUGmZ

Star Ratings impact your Medicare plan’s reputation — and whether or not consumers choose you over the competition. No doubt you're aware that CMS has recently made significant changes to Medicare, including how plans are graded. We’re exploring what’s different for Star Ratings in 2024. Could an engagement program be a step in the right direction to solve member needs and boost your Star Ratings? https://hubs.li/Q02DvD2B0 #Medicare #StarRatings