Across H1 2024, the Strategy Catalyst team presented our MA research to Chief Strategy Officers, Chief Financial Officers, Vice Presidents of Finance, Chief Physician Executives, and Chief Revenue Cycle Officers and prompted discussions around how they are evaluating or rethinking their MA strategies. We published two pieces in response: the first reflects insights from these discussions, while the second (this publication) overviews the market update we provided to these leaders. It also serves as a follow up to the MA predictions we published in February.
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Preview of the 5 Insights
Despite setbacks in MA, the reality may not be as bad as payers are making it out to be. Winners may emerge, widening the gap between the “haves” and “have-nots.”
CMS recalculation of star ratings after legal losses provides a windfall for plans.
A bombshell report finds CMS paid $50B for “questionable diagnoses.” While upcoding scrutiny is nothing new, this could shift Congressional favor against payers.
The Chevron reversal will slow down future regulatory changes and CMS’ supervisory efforts of the past year—a huge challenge for health system desires to rein in payers.
Trump's potential return has boosted MA share prices, suggesting a more favorable regulatory environment for MA payers if he is re-elected.