primarycare

Enrollment in Medicare Advantage continues to climb as we enter enrollment season I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing month-over-month increases. The growth is tied to remaining strong benefit packages for 2024. Increases in MA enrollment still occur outside of the enrollment season given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes throughout the year. New enrollees see huge value in enrolling in MA over the traditional fee-for-service (FFS) program. This value difference will continue to drive growth in 2025. Open enrollment began October 15 for 2025 benefits. We normally would see enrollment pick up a great deal in November and December as some switch to their new plans early. But that is unclear because many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines.

Note: This Healthcare Labyrinth blog was written and co-published in collaboration with Lilac Software, a new data analytics technology and insights firm I co-founded with Neetu Rajpal and Alex Schaefer. Lilac’s data scientists are hard at work analyzing all the Star Year 2025 results and recent trends. Check out Lilac Software’s website for additional research and analysis at https://lilacsoftware.com as well as Lilac’s LinkedIn page at https://www.linkedin.com/company/101172520/admin/dashboard/ . While the Medicare Advantage (MA) Star program has always made it difficult for plans to achieve and maintain high Star scores, the Star roller coaster ride has been much more profound over the past several years. We have seen three years now of falling results – the 2023, 2024, and 2025 Star Years. In some ways the 2023 year was a “return to normalcy” (with apologies to President Warren G. Harding) after banner Star ratings in the two years prior that were driven

CMS needs to stop hiding the ball on coverage impacts and make amends for misleading Medicare beneficiaries I am generally a supporter of the Centers for Medicare and Medicaid Services (CMS). I think it tries very hard to help deliver quality care and regulate Medicare Advantage (MA) and providers reasonably. As a former government official and regulator, I am sympathetic to the agency’s need to constantly walk a tight rope when it comes to policy decisions. I have even backed some CMS decisions when the health plan industry has been vehemently opposed. But I am sorry to say that I have lost some faith in CMS recently. In blogs and newsfeeds I have questioned some of the agency’s actions. I see the agency reacting much more politically of late. This is especially true for MA and Part D decision-making in the last year or so. What happened in Medicare Advantage? While

The time has come for a real fix to Medicare physician fees. The big stall is hurting healthcare. Poor Medicare docs. They have been on a proverbial reimbursement roller coaster for decades now. The ups and downs have undermined independent practices, led to our primary care deficit, and actually fostered physician group acquisitions that increase costs in the healthcare system in several ways. More background A caution before I give you details on the history of Medicare physician pay — I am by no means a traditional Medicare fee-for-service (FFS) program rate expert. So, I am keeping this short and giving you a broad overview. The long and short of it is that Medicare physicians have had a rather broken rate system dating back to 1992. The bad system has been undermined further with various budget reduction requirements applied to the physician rates along the way. Congress created the Medicare