Episode Description
On this episode of The Health System CXO Podcast, Jackie Kimmell, Sr. Director - Member Insights at The Health Management Academy, discusses Medicare Advantage (MA) and its impact on health system executives.
She also discusses the growth and significance of MA in the healthcare industry, the profitability for payers, the benefits and challenges for beneficiaries, and the struggles health systems face. She also highlights the regulatory changes and headwinds that have affected the profitability of MA plans, leading to decreased margins for payers and lower yields for health systems.
Lastly - she shares the insights Strategy Executives need to know regarding the variations in MA penetration across different markets and the importance of understanding the MA landscape for healthcare executives.
Key Takeaways
1.Medicare Advantage (MA) is a major topic of concern for health system executives due to its significant impact on the healthcare industry.
2.Payers have prioritized MA and have seen high profit margins, but regulatory changes and headwinds have affected their profitability.
3.MA offers benefits such as low premiums and supplemental benefits, but there may be hidden downsides and challenges for beneficiaries.
4.Health systems have contracted with MA plans to benefit from higher reimbursement rates, but they face challenges such as claims denials and lower yields.
5.Understanding the MA landscape is crucial for healthcare executives to navigate the changing market and ensure financial sustainability.
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.