Facing a shifting regulatory landscape and provider tensions, some insurers have reached a crossroads with Medicare Advantage. This year proved pivotal in shaping how payers would move forward.
Here are the 3 biggest trends from the year:
1. Coding intensity has been a major concern in MA. The Medicare Payment Advisory Commission attributed $40 billion in additional federal spending to coding intensity alone. This year, insurers addressed increased emergency room use, greater morbidity, and steeper demand for behavioral health and specialty drugs — especially in MA. Provider coding practices may underlie some of these worries. Several health insurance leaders, including UnitedHealthcare CEO Tim Noel and Elevance CEO Gail Boudreaux, cited pressure from coding intensity on their businesses. The independent dispute resolution process under the No Surprises Act has been another sore spot, pitting payers and providers against one another as they distribute and collect payment.
2. MA has been a hot topic in Congress, with Becker’s reporting on at least eight relevant bills. Reforms came from both sides of the aisle and addressed payment efficiency, risk adjustment methodology and prior authorization.
3. Amid cost-containment efforts and steeper medical expenses, insurers have been reconfiguring their approach to MA. A handful of insurers have been fully exiting the market, including Cigna, Samaritan Health Plans, Blue Cross Blue Shield Vermont and Sentara Health Plans.
