
Medicare Advantage Needs To Pivot To Thrive Again
Changes in prior authorization, the Star program, and risk adjustment will force MA plans to pivot to aggressive data analysis and intervention to reduce costs and improve quality. Investor news is crazy with various news about major health plans and the struggles they are seeing. The biggest light has been focused on the sad financial news of Medicare Advantage (MA). There are 340 million people in the country, and there are now almost 70 million seniors and disabled on Medicare. While some major health players, such as The Cigna Group, have divested Medicare plan assets, most others see MA as critical to insurer success overall. After all, MA has huge premiums (let’s say about 2.5 to 3 times other lines of business) and should have margins that are among the best (perhaps 4 to 6% in good years like commercial, compared with 2% at best in Medicaid and the Exchanges).