Medicare Advantage enrollment is on the rise, with insurers seeing opportunity as more people become eligible for Medicare. However, health systems are facing challenges with these plans as denials and inconsistent reimbursement have led to a 28% drop in hospital cash reserves. According to a joint report by the American Hospital Association and Syntellis, Medicare Advantage denials rose almost 56% for the average hospital from January 2022 to July 2023.
One health system, UNC Health, has found it difficult to work with Medicare Advantage plans that deny care and boost earnings. This has led to partnerships with more reliable payers and a potential contraction with Medicare Advantage plans that are not good partners. CFO Will Bryant of UNC Health expressed hope during a panel at the Becker’s 11th CEO+CFO Roundtable that future payer-provider partnerships will help solve the problems that have arisen over the last 30-plus years.
In response to these challenges, CMS is proposing more regulations to address the issue. These include prohibiting volume-based bonuses to third-party marketing organizations and requiring health plans to provide a mid-year notice for enrollees about any supplemental benefits changes enacted. The hope is that these regulations will lead to better partnerships and communication between health systems and Medicare Advantage plans.