Shift to Medicare Advantage Ratchets Up Pressure on Hospitals

The move to private Medicare Advantage takes hospitals further away from fee-for-service medicine, putting pressure on these providers to improve quality and health outcomes or risk being excluded from insurer networks.

Hospitals are seeing an unprecedented number of patients covered by Medicare Advantage as health insurers take on a larger role in administering health benefits for aging baby boomers.

The swift move to private Medicare Advantage also takes hospitals and health systems further away from fee-for-service medicine, ratcheting up pressure on these providers to improve quality and health outcomes or potentially be excluded from insurer networks as part of value-based models that are proliferating.

“Hospitals will have a hard time not playing ball with MA plans,” says Andrew...