Managed Healthcare Executive February 3, 2025
2024 may go down as the high-water mark for Medicare Advantage. While the Medicare Advantage program continues to grow, the forces that drove that growth are under increasing scrutiny, with financial and regulatory pressures forcing payers to rethink their strategies. Last year, contract disputes over reimbursement rates led some healthcare providers to drop Medicare Advantage plans altogether. Meanwhile, changes to risk adjustment rules (i.e., V28) and Star Ratings thresholds (i.e., cut points) pose challenges for payers.
Historically, payers have attracted beneficiaries with generous benefits and broad provider networks, but tightening margins and regulatory headwinds may mean the days of freewheeling growth are over. These shifts signal a need for a more disciplined, data-driven approach to grow revenue, control costs and,...
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