As large national Medicare Advantage carriers face financial headwinds and tensions with health systems, one New York payer says business in the market is booming.
"Across the country, you're seeing hospitals that have stopped accepting for-profit Medicare Advantage plans," Nick Kraft, Chief Growth Officer at Capital District Physicians' Health Plan, told Becker's. "Providers are tired of not being paid on time and jumping through hoops. As a local plan, we don't run into these problems because we work hard with our local systems on this issue."
CDPHP has about 400,000 total members, including 63,000 enrolled in Medicare Advantage. MA membership is up 26% year over year, and the Albany-based company boasts a 98% retention rate. In 2023, it was named the top MA plan in New York by the NCQA, U.S. News, and achieved a 5-star rating from CMS.
"Consistency is important to us when it comes to Medicare Advantage," Mr. Kraft said. "The worst thing you can do is try and buy the market with flashy benefits and then pull back later, because that hurts seniors."
Across the country, some health systems have ended their relationship with Medicare Advantage, or slimmed down the number of carriers they contract with. Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. The trend is evident within CDPHP's local market.
Community Care Physicians, an independent physician group of 420 clinicians across 70 practices, dropped Humana Medicare Advantage in March. Community Care is affiliated with CDPHP.
On July 1, Albany Med Health System will also no longer contract with Humana MA across four hospitals in the region.
"Our growth is based on our connection to our provider community and a benefits structure closely associated with our members' needs." Mr. Kraft said. "We work closely with our local health systems on Medicare Advantage, and we're able to have these robust conversations because they're based on trust built over time."