Who Really Benefits From Medicare Advantage Plans?
By Admin | December 14, 2023
Who Really Benefits From Medicare Advantage Plans?
Health systems have been increasingly dropping MA contracts, saying that they cause their organizations to lose too much money and result in dangerous patient care delays. To mitigate this issue, experts think large MA plans need to delegate more utilization management duties to health systems rather than handling it themselves.
Every autumn, American television viewers are inundated with a barrage of commercials depicting the vibrant and wondrous life they could be living under the coverage of a Medicare Advantage plan. These advertisements are full of celebrity spokespeople, seniors showing off their athleticism and promises that MA plans provide better benefits than traditional government-operated Medicare plans.
But ads often exaggerate value — and in the eyes of some health systems, these commercials paint an egregiously false picture of what MA plans really offer.
Over the past year, health systems have been increasingly dropping MA contracts, saying that they don’t pay enough and result in dangerous patient care delays. Both large and small health systems — from WellSpan Health and Vanderbilt Health to smaller community hospitals across the country — have been doing away with their MA contracts, citing large losses on the plans as the main reason for termination.
Most of the nation’s largest MA plan administrators, including UnitedHealthcare, Humana, Aetna and Cigna, did not respond to MedCity News‘ requests for comment for this article.
“Delay, deny or don’t pay”
In September, San Diego-based Scripps Health announced that its two largest medical groups will stop participating in MA plans starting January 1. More than 30,000 MA enrollees covered by UnitedHealthcare, Blue Shield of California, Anthem Blue Cross, Centene’s Health Net, SCAN Health Plan and a few other smaller payers will be affected.
A major reason for this decision is that MA contracts are causing Scripps to bleed money, said Tracy Chu, corporate vice president of population health and chief executive of Scripps’ accountable care organization, in an interview last month.
“We’re losing $75 million a year in taking these contracts. So our CEO, Chris Van Gorder, made the decision to not continue those contracts with those two medical groups. We could not come to consensus in terms of rates,” she explained.
Van Gorder uses the phrase “delay, deny or don’t pay” to describe the culture at MA plans, Chu added.
As Chu sees it, insurers are expecting health systems to be full from...(More)
For more info please read, Who Really Benefits From Medicare Advantage Plans, by Med City News
