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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.
35:11
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Quick takeaways
- The future of the Medicare Advantage Stars Program may involve significant changes to ensure accurate reflection of health plan quality amid recent legal challenges.
- Stringent government oversight on risk adjustment practices is anticipated to evolve, addressing concerns over improper payments and their impact on beneficiary care access.
Deep dives
Future of Medicare Advantage STARS Program
Recent changes and lawsuits surrounding the Medicare Advantage STARS program highlight its critical role in determining plan quality. The program was designed to offer bonus payments to health plans based on their performance in various quality measures, which are reassessed yearly. Many health plans are currently contesting the methodology and transparency of how these star ratings are calculated, questioning whether they truly reflect the quality of care provided. Given the recent litigation victories for these health plans, it is anticipated that the incoming administration will reassess the STARS program structure, ensuring it better represents health plan quality and beneficiary experience.
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Discover
highlights
Listen to the best highlights from the podcasts you love and dive into the full episode