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Medicare Advantage Payment Scrutiny

The Healthcare Revolution with MHK

Release Date: 10/29/2021

Healthcare Update: 2022 Year-in-Review & 2023 Predictions  show art Healthcare Update: 2022 Year-in-Review & 2023 Predictions

The Healthcare Revolution with MHK

It was a busy year in 2022 for healthcare. In this edition of The Healthcare Revolution podcast, MHK President Marc S. Ryan reviews what happened in 2022 surrounding healthcare and what you can expect in 2023 given the split Congress.

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Election Results and the Impact to Healthcare show art Election Results and the Impact to Healthcare

The Healthcare Revolution with MHK

With the Congress split in 2023 in terms of political control, the prospect for major healthcare legislation is in doubt. In this episode of the Healthcare Revolution, MHK president Marc S. Ryan covers what happened in the midterms and what we can expect over the next two years on the healthcare front.

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Medicare Advantage and Star Ratings – Recent Trends and the Critical Importance of the Program to U.S. Healthcare show art Medicare Advantage and Star Ratings – Recent Trends and the Critical Importance of the Program to U.S. Healthcare

The Healthcare Revolution with MHK

Medicare Advantage Star ratings are in the news, with announcements that Star ratings dropped dramatically from 2022 to 2023. MHK’s president Marc S. Ryan tells you all you need to know about Medicare Advantage, including the background on the program, why it is important to health plan financing, and recent controversies about whether Star truly improves quality or not. His view is clear – Yes it does. And, it’s the most comprehensive and proven quality program in U.S. healthcare.

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MHK Interview with Dr. Marty Makary, MD MPH show art MHK Interview with Dr. Marty Makary, MD MPH

The Healthcare Revolution with MHK

In this latest episode of The Healthcare Revolution with MHK, president Marc S. Ryan speaks with Dr. Marty Makary, MD MPH a leading healthcare reform expert and author of The New York Times bestseller The Price We Pay. It’s an intriguing conversation you don’t want to miss.

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Drug Price Reform – Why all the fuss? show art Drug Price Reform – Why all the fuss?

The Healthcare Revolution with MHK

Two major healthcare provisions were included in the Democratic reconciliation bill known as the Inflation Reduction Act. They include extension of Exchange premium subsidies and Medicare drug price reforms. In this edition of the Healthcare Revolution with MHK, MHK President Marc Ryan discusses both important issues. Most importantly he asks: “Why all the fuss about drug price reform?”

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Major Changes in Store for Medicare Advantage and Part D Plans show art Major Changes in Store for Medicare Advantage and Part D Plans

The Healthcare Revolution with MHK

In the latest edition of The Healthcare Revolution podcast, MHK president Marc S. Ryan reviews the recent Health and Human Services Office of Inspector General report regarding prior authorization in Medicare Advantage (MA) plans and the push for reforms and restrictions on utilization management in the MA private plan alternative to traditional fee-for-service (FFS). In addition, Marc provides an overview of the final 2023 MA and Part D rule. Major changes are in store for MA and Part D plans.

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Aduhelm and the Microcosm of What is Wrong with our Drug Approval and Pricing Process show art Aduhelm and the Microcosm of What is Wrong with our Drug Approval and Pricing Process

The Healthcare Revolution with MHK

In this edition of The Healthcare Revolution podcast, MHK President Marc S. Ryan examines the recent controversy over the approval of Aduhelm and the backtracking the government did on coverage of the drug in Medicare. It is a microcosm about what is wrong with our drug approval and pricing process.

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The ACA Turns 12 show art The ACA Turns 12

The Healthcare Revolution with MHK

The Affordable Care Act turned 12. In this edition of The Healthcare Revolution podcast, MHK’s President, Marc S. Ryan tells you about the history of the ACA, the turmoil from Obama to Trump to Biden, and the accomplishments in terms of healthcare coverage expansion. He then reviews some looming risks to coverage.

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Interoperability Rule to Reduce Healthcare Costs and Improve Quality show art Interoperability Rule to Reduce Healthcare Costs and Improve Quality

The Healthcare Revolution with MHK

The federal government says health plans and providers should be in store for a big interoperability rule in the Spring of 2022. The rule promises to clarify some existing rules and bring about medical electronic prior authorization and data-sharing between payers and providers. It will clearly define integration standards to use. While it will take time and cost to implement, it is a key initiative to reduce healthcare costs and improve quality.

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Health Plan Profit Margins show art Health Plan Profit Margins

The Healthcare Revolution with MHK

Health plan profit margins are out and they show that health insurers continue to be responsible players in the healthcare system. This is driven by the adoption of the Minimum Medical Loss Ratio (MLR) across the lines of business. Learn about the minimum MLR, how it limits margins, and the results for 2021.

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More Episodes

Medicare Advantage is seeing a great deal of payment scrutiny. Listen in as MHK president, Marc S. Ryan discusses how Medicare Advantage health plans get paid, what critics are saying, and what the future may hold.