News-Medical.Net October 8, 2024
Institute for Operations Research and the Management Sciences

New findings from a team of renowned researchers calls for transparency and rigorous oversight of the U.S. Medicare Advantage (MA) program, the United States’ largest healthcare capitation program.

The new research, published in the INFORMS journal Manufacturing & Service Operations Management, finds evidence that some MA health plans conduct strategic cross-subsidization, offering extra benefits in some areas to attract healthier, less costly patients, while providing fewer benefits to sicker patients. Through such strategic cross-subsidization, health plans can unfairly increase their profits resulting in reduced care quality for sicker patients and obvious inequity in care.

Our findings open the black box of Medicare Advantage operations, revealing a previously unknown resource misallocation problem.”

“Our work underscores the urgent need for...

Today's Sponsors

LEK
ZeOmega

Today's Sponsor

LEK

 
Topics: Insurance, Medicare Advantage, Survey / Study, Trends
Elevance Health latest insurer to sue over Medicare Advantage star ratings
Medicare Advantage problems are getting worse, not better, lawmakers say
Contributor: Vulnerable Seniors Are at Risk With Looming Medicare Advantage Cuts—Income-Based Programs Can Minimize the Damage
Bar Keeps Rising For Medicare Advantage Star Ratings
Humana boosts 2024 earnings guidance thanks to Medicare Advantage member retention

Share This Article