AI used by brokers to pick plans to sell:
https://generations.asaging.org/medicare-decisions-should-not-be-left-ai
Prior Authorization prevents you from getting the health care you need:
https://ldi.upenn.edu/our-work/research-updates/the-billing-bottleneck-how-medicare-advantage-insurers-use-prior-authorization/
MA patients have lower rate of hospitalizations, and that might not be a good thing:
https://www.fiercehealthcare.com/payers/study-details-why-medicare-advantage-avoidable-hospitalizations-lower-compared-traditional
Humana decided there's more money to make in selling Medicare Advantage that selling Employer Group Health Plans:
fiercehealthcare.com/payers/humana-shed-employer-group-commercial-business
Surprise Billing:
https://www.fiercehealthcare.com/payers/cms-astronomical-volume-surprise-billing-dispute-cases-taking-toll-agency
Kaiser discussion on 2023 Medicare Advantage payments
One of the speakers, Tom Kornfield, spent 10 years at CMS before he went into the private sector. He has a vested interest in disparaging the payment changes the federal government is trying to make to MA plans. I point this out because this CMS changes affect his clients and thereby, indirectly affects the consulting fees his firm will get. I find it hard to believe his spin because of it. This is his background: Tom also spent 10 years working at the Centers for Medicare & Medicaid Services (CMS), where he held a variety of positions focused on MA and Part D payment policy. Specifically, Tom analyzed MA bids and payments and changes in MA payment rates, and he created a policy to allow for 5-star MA plans to market and enroll year-round.
Action Now Initiative March 3, 2023 letter to CMS captures why CMS needs to rein in the excesses of Medicare Advantage Billing:
https://www.arnoldventures.org/stories/whats-going-on-with-medicare-advantage-arnold-ventures-experts-explain
Analysis of how MA plans are sucking money out of Medicare. It is soooo complicated. Why won't the federal government stop the shenanigans?
