87. 2024 Medicare Advantage and Part D Program Audit Enforcement Report Out: What Does It Tell Us?
The Healthcare Labyrinth
CMS’ Medicare Advantage (MA) program audits are getting tougher and more detailed every year. 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...
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86. Will The New 100% RADV Audits Be Fair To Medicare Advantage Plans?
The Healthcare Labyrinth
While justified, there is some question about whether the new RADV audits will be fair to MA plans. 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...
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85. Healthcare Developments Beyond The One Big Beautiful Bill
The Healthcare Labyrinth
The Big Beautiful Bill buried some other important healthcare developments. 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...
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84. The One Big Beautiful Bill Passes
The Healthcare Labyrinth
The one big beautiful bill has passed. Listen in to learn about how it happened and the impact of healthcare reductions. 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...
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83. Are There Smarter Healthcare Cuts?
The Healthcare Labyrinth
There are smarter healthcare cuts and sensible reforms that could be made and spare major impacts to coverage. 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...
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82. Will Health Plan Pain Continue?
The Healthcare Labyrinth
As bad as health plans have had it the past few years, trends seem to show the pain continuing. 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...
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81. How Mighty Big Healthcare Has Fallen
The Healthcare Labyrinth
The mighty big healthcare companies have fallen, in this case a victim of their own financial mismanagement and shenanigans. 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...
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80. Republicans Are In Stealth Mode On Healthcare Coverage Cuts, But The Impact Is Real
The Healthcare Labyrinth
The GOP is not following the same overt repeal of healthcare coverage as it did in 2017, but the stealth approach still has real impact. 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...
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79. Managed Care Enters New Cycle; Medicare Advantage Needs To Pivot To Thrive
The Healthcare Labyrinth
Managed care is entering a new conversion cycle just as Medicare Advantage plans have to pivot to thrive. 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...
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78. The Budget Reconciliation Saga
The Healthcare Labyrinth
The House has passed the budget reconciliation bill, but the Senate intends to put its mark on the bill and there are competing forces as in the House. Final passage is some time off still. 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...
info_outlineAbout 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 the financial state of health plans. As bad as health plans have had it the past few years, trends seem to show the pain continuing.
Key Takeaways:
Last week we discussed how every health plan is undergoing financial strain, but Big Healthcare was especially hurting right now.
Compound Annual Growth Rate EBITDA for health insurers dropped by 1.2% from 2019 to 2024.
So, will all these struggles continue for the foreseeable future, despite most big health insurers seemingly beginning to dig themselves out of their financial mess?
Healthcare trends as well as government actions will most assuredly mean continuing bumpy times in all lines of business.
A return to pre-pandemic utilization demand and cost growth of weight-loss, specialty, and medical drugs are creating major medical expense challenges for plans.
On the employer front, businesses will continue to demand greater accountability from their healthcare entities.
Millions (over 8 million) could leave the Exchanges, which brings back the prospect of fewer plans, skyrocketing premiums, and higher risk.
Plans have complained that Medicaid rate hikes are not keeping up with the costs from rising risk. We could see the same phenomenon as more leave the Medicaid rolls.
Utilization trends and the threat of major risk adjustment revenue recoupment in Medicare Advantage could lead to greater retrenchment than expected.
Plans will need to further adjust their recovery assumptions as they seek to turn around margins.
Downsizing, administrative reductions, and moving from a prior authorization focus to intervention and care management are essential.
Connect with Marc
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