Becker's Healthcare March 14, 2024
Medicare Advantage provides coverage to more than 51% of the nation’s seniors, but many hospitals and health systems are pushing back against commercial programs, with some dropping contracts with private plans altogether.
Excessive prior authorization denial rates and slow payments from insurers are some of the biggest challenges providers face with MA programs, but St. Louis-based Mercy CFO Cheryl Matejka maintains that MA is a good model when structured appropriately.
“It helps keep incentives aligned if commercial contract terms are appropriate. Patients like the model in our markets and, I would argue, across the country,” Ms. Matejka told Becker’s. “We want to adapt to serve our communities, and our patients that like those models. That being said, the model needs...
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