Relentless Health Value EP463: Medicare Advantage Policies—Which Will Stay and Which Will Go Now? With Betsy Seals
Feb 13, 2025
Betsy Seals, CEO and co-founder of Rebellis Group, dives into the evolving landscape of Medicare Advantage policies. She examines the potential shifts in the Medicare Advantage Stars Program due to lawsuits and the new administration's guidelines. There's an engaging discussion about risk adjustment practices, AI's role in prior authorization, and increased scrutiny on agent marketing tactics. Betsy stresses that Medicare Advantage plans must focus on patient value and innovative data use to navigate these changes effectively.
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Star Ratings Lawsuits
- Health plans are pushing back against CMS star rating calculations.
- Lawsuits question the program's quality, transparency, and if it reflects beneficiary experience.
STARS Program Future
- The new administration will likely re-evaluate the STARS program.
- Changes are expected to ensure it reflects plan quality and beneficiary experience.
Medicare Advantage Profitability
- Medicare Advantage is theoretically profitable due to reimbursement rates.
- However, many factors can lead to its failure, including regulations and strategies.