The 'critical success factor' behind BCBS Michigan's Medicare Advantage program

Medicare Advantage organizations are facing major challenges, including rising utilization rates, reduced reimbursements, and an evolving regulatory landscape.

Krischa Winright, president of Medicare Advantage at Blue Cross Blue Shield of Michigan, joined the Becker's Payer Issues podcast to discuss how BCBSM is navigating the MA environment, an episode that will air later this month. Tune in to hear about how the company is strategizing for 2025 and working to meet the unique healthcare needs of more than 650,000 seniors.

Question: How is BCBS Michigan navigating the Medicare Advantage headwinds we're seeing across the industry?

Krischa Winright: Partnerships with providers. That's central to what Blue Cross is and where we're really leaning in because that's what it will take for everyone to be successful in the Medicare Advantage program. We also have strong relationships with employers in our market. We're all aligned and are passionate about solving for affordability and access to excellent healthcare. These Medicare Advantage trends affect all the providers, employers and seniors in our market.

We see higher utilization rates and CMS reimbursement reductions as the signaling of a market shift. The work we've been doing to meet the needs of the older population drove a lot of competition with rates and benefits, and now they're correcting the funding to make sure that it's sustainable for the long term.

One recent example of the work that we're doing in this space is with providers that participate in our Blueprint for Affordability program. Currently, more than 50% of our total commercial Medicare Advantage membership in Michigan is covered by physicians participating in the shared-risk model. That's a total of 22 physician organizations that have signed on to the program, making it one of the largest payment models of its kind in the nation. That work acknowledges that you can't solve for this level of change alone, and that we all need to evolve together to make the program work in the best way that CMS has laid out.

It's also incumbent upon us to clear any confusion for seniors about how we are aligned with their physician. Seniors don't want conflicting messages, they want to know how to get the best care. Our work is to make sure that we're partnering with their healthcare providers — that's the number one critical success factor that we're leaning into right now.

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