Blake Madden’s Post

Strategies for Success in the Face of Medicare Advantage Challenges As the Medicare Advantage landscape becomes increasingly complex, with regulatory changes, high utilization trends, and funding stagnation, it is essential to identify and implement effective strategies to ensure success. **1. Membership Shifts and Pricing/Benefits Adjustments:** Anticipate shifts in membership and proactively adjust pricing and benefits to cater to the changing needs of the target population. **2. Synergistic Approach to Coding, Quality, Engagement, and Network Management:** Break down silos and establish a collaborative process that integrates coding, quality, engagement, and network management to optimize performance. **3. Utilization Management and Total Cost of Care Control:** Implement strategies to manage utilization and control the total cost of care, including exploring digital, virtual, and alternative forms of care to enhance affordability and accessibility. For further insights and a more detailed discussion, please feel free to reach out directly. #medicareadvantage #affordability #totalcostofcare #healthcareinnovation #optum #utilizationmanagement

Second largest #MedicareAdvantage player and now almost exclusively a one-act pony, #Humana calls for more government regulation(!) as #CMS adjusts risk adjustment methodologies, #quality scoring star cut points, base rates & “consumers”consume more #healthcare services provided by “providers” coming out of the #pandemic. The one thing that Humana and all other MA players have got going for them is statuatory pass-through non-network national unit pricing control not found anywhere else in US healthcare. Meanwhile, on the employer-funded side of healthcare finance, total costs (total volume times average unit pricing) continues to accelerate at double the background inflation rate. Will only the largest, highest quality MA players ultimately survive? Could be. #CVS #Aetna #HealthcareTransformation #HealthcareReform #HealthEquity #PrimaryCare #PublicPrivatePartnership #PublicPrivatePartnerships

Is it ok to take less risk in a Medicare Advantage VBC contract? I spoke at the Rise VBC conference Tuesday about the head winds in MA (https://lnkd.in/epG5JQ-K), and I am surprised I didn't get this question more often. 𝐐𝐮𝐞𝐬𝐭𝐢𝐨𝐧𝐬 𝐈 𝐠e𝐭 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐨𝐟𝐭𝐞𝐧: - How will part D impact me in 2025? - What can we do about supplemental benefits? - What is the impact of v28? 𝐐𝐮𝐞𝐬𝐭𝐢𝐨𝐧𝐬 𝐈 𝐰𝐢𝐬𝐡 𝐈 𝐠𝐨𝐭 𝐦𝐨𝐫𝐞 𝐨𝐟𝐭𝐞𝐧: - What are the options to reduce risk through the next few cycles? - If we can get through 2025 can we get to sustainability? - What contract terms can we use to reduce, cap or eliminate risk? There are a number of very recent examples that show growth at all cost is a slippery slope. What if we slowed growth, managed risk and lived to treat another beneficiary?

Did You Know? In 2025, significant changes are coming to Medicare Part D! The Inflation Reduction Act introduces a $2,000 out-of-pocket spending cap...will this affect YOUR plan's creditability? Make sure to stay informed and consider how these changes may impact your plan’s creditability and your distribution strategy by reading my article on the subject. Prepare now for this fall’s 2025 Medicare Part D notice requirements.

Our actuarial healthcare team used our advanced Healthcare Reform Microsimulation Model (HRM Model) to understand the impact on the cost of coverage if the enhanced ACA tax credits were to expire for enrollees with chronic conditions. More to come on this topic!

A series of insights are coming from the Oliver Wyman Actuarial team regarding the impact of enhanced tax credits expiring at the end of 2025 - read the first post now, focused on patients with chronic conditions.

Here's language that #financialadvisors can safely use NOW in their client newsletters. I will offer revised and detailed verbiage you can/should use after we have visibility on 2025 Medicare plans. For now........ "At (your firm), we are expecting the final phase in of the Inflation Reduction Act to affect EVERYONE on Medicare. Every September, everyone on Medicare gets an " Annual Notice of Change" from their Medicare drug coverage insurer, laying out their CURRENT plan benefits in the current year, vs. the plan benefits in the upcoming year . No one every reads these. In September 2024, EVERYONE should read their Annual Notice of Change. If you'd like guidance on how to navigate the impacts of the Inflation Reduction Act on your Medicare Part D Rx plan EARLY in the upcoming Annual Enrollment Season, we can provide an introduction that that part of our financial planning process."

Humana: Medicare Advantage May Fail Without Regulator Intervention, Threatening Core Business https://lnkd.in/ektTB9zb So it turns out that when you are in a healthcare/people business and you burn relationships with, hospital, doctors and patients that your business collapses. who could hav we seen the decline of your business

Thursday Fast Facts Medicare Final Rule IPPS update trends To determine rates for each calendar year, Medicare utilizes the projected hospital market basket increase reduced by a productivity adjustment based on nonfarm business multifactor productivity or “MFP adjustment.” The impact of this adjustment varies over time. (Note that other adjustments including statutory and legislative mandates are also applied, which means that the update is sometimes higher than the market basket.)

Coming out of the Q3'24 earning season, we are paying close attention to how Medicare Advantage Organizations are changing their service areas and product strategies for 2025. Analysts were highlighting potential for large market contractions: however, the newly released data suggest that the market is relatively stable with some give and takes. Are you interested in how the #MedicareAdvantage competitive landscape is changing where you operate? Reach out to us at [email protected] for more detail by county or plan type.