Episode Description
Jackie Kimmel, your Health Systems CXO Podcast host for Strategy Executives, discusses the challenges and trends in Medicare Advantage (MA) contract management. Jackie highlights the declining yield from MA contracts and the negative impact on health system financial sustainability. The increasing number of audits, denials, and prior authorizations from MA payers is also a major pain point for health systems. Contract terminations are becoming more common, with many health system executives considering terminating at least one major plan in the next year. The viability of provider-sponsored health plans in MA is also discussed, with some systems slowing down growth while others see it as a leverage point in negotiations.
Key Takeaways
1.MA contract management must be more strategic and active to address declining yield and financial sustainability challenges.
2.Health systems are facing increasing audits, denials, and prior authorizations from MA payers.
3.Contract terminations are becoming more common, with health system executives considering terminating major plans.
4.The viability of provider-sponsored health plans in MA is a topic of debate.
5.CMS regulations and legislative actions are impacting MA contract management.
6.There is a growing divergence in performance between different MA plans. Utilization trends and court cases will shape the future of the MA landscape.
The full transcript of our conversation is also available to read. Show the Transcript.
About Our Host
Jackie Kimmell, Senior Director of Insights & Market Intelligence
Jackie Kimmell brings a unique perspective by providing market intelligence on emerging trends for top health systems.