Forbes December 5, 2022
Over the last year, Medicare Advantage (MA)—the publicly funded program that enables private insurers to manage health benefits for older adults and people with disabilities—has come under the microscope. Policymakers, journalists, and health industry analysts are assessing the effect of the growing program on federal expenditure and quality of care.
As the CEO of not-for-profit Medicare Advantage plan, these are welcome assessments as the imperfect program has a host of shortcomings that are worthy of evaluation. Among these shortcomings are the system of risk adjustment that may be over-paying for the care of some patients; the insidious use of utilization management practices to deny care to patients who need it; and the use of dubious direct-to-consumer advertising that sometimes confuse...
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