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The future strategy of health systems in Medicare Advantage


Nov 20, 2023

Health systems have been facing challenges with Medicare Advantage plans, including delayed and denied coverage, leading some to drop contracts with the private plans. According to data from a report by the American Hospital Association and Syntellis, Medicare Advantage denials increased by almost 56% for the average hospital from January 2022 to July 2023. This, along with inconsistent reimbursement, resulted in a 28% drop in hospital cash reserves.

Despite these challenges, Medicare Advantage enrollment is increasing, with insurers identifying opportunities with these plans as more people become eligible for Medicare. In the last year, Medicare Advantage enrollment grew by 8%, adding 2.3 million beneficiaries, according to KFF.

During a panel at the Becker’s 11th CEO+CFO Roundtable, Will Bryant, CFO of UNC Health, spoke about the health system’s experiences with Medicare Advantage plan denials. Bryant mentioned that while the health system aims to expand partnerships with payers in some areas, they are likely to scale back with Medicare Advantage plans that do not perform well and are not good partners for the system.

Bryant emphasized the need for providers to communicate and partner with payers more effectively to develop mutually beneficial solutions, without having to face pressure from CMS or others. He expressed hope in the potential for payer-provider partnerships to address some of the challenges that have arisen over the years.

On the regulatory front, CMS is focusing on Medicare Advantage marketing tactics and has proposed additional regulations to address certain issues, including prohibiting volume-based bonuses to third-party marketing organizations and requiring health plans to provide mid-year notices for enrollees about any changes to supplemental benefits.

By Editor

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