79. Managed Care Enters New Cycle; Medicare Advantage Needs To Pivot To Thrive
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79. Managed Care Enters New Cycle; Medicare Advantage Needs To Pivot To Thrive
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About this listen
About The Podcast:
Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.
Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.
Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.
Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.
Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.
Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.
About The Episode:
On this episode, Marc discusses two major trends in healthcare. Managed care is entering a new conversion cycle. And Medicare Advantage needs to pivot to thrive.
Key Takeaways:
We are entering a fourth conversion cycle for managed care in America.
The first cycle was the birth of managed care to eliminate the transactional indemnity system.
The second cycle was a managed care backlash due to the huge utilization clampdown and too little choice.
The third cycle involved governments pursuing compliance, accountability, and quality reforms.
The current cycle involves the advent of value-based care and digital healthcare.
Medicare Advantage is facing a sea change, with governments restricting prior authorization, making quality programs more complex, and reining in liberal risk adjustment revenue practices.
The above along with surging utilization and healthcare trends mean Medicare Advantage (MA) plans are in a financial crisis.
MA plans need to pivot from upfront gatekeeping using utilization management to a focus on wellness, prevention, and care management.
MA plans need to invest in technology and personnel to assess quality outcomes, member risk and cost trends, and member satisfaction.
A mature data analytics platform deriving real-time assessment of factors as well as leveraging artificial intelligence (AI), machine learning and agentic AI engagement could be how all plans rise to the occasion and pivot their enterprises for financial success in MA.
Connect with Marc
Marc on LinkedIn Marc on Twitter THL Podcast Resources THL’s Newsfeed THL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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