The Trump Administration is on a VBC reform model fury. It deserves credit but there are potholes ahead on its reform map.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the Trump administration's VBC reform model fury. It deserves credit but there are potholes ahead on its reform map.

Key Takeaways:

Medicare FFS is badly in need of reform and CMS has been introducing VBC payment models for a number of years.

The Trump administration has been on a model fury, seeking to set its mark on healthcare reform.

It is introducing reforms leveraging technology and expanding VBC payments.

But the model fatigue of the past is setting in again with numerous new models and aggressive timeframes.

The tech-enabled ACCESS model was extended to obtain more tech company participants.

The ACO LEAD model may not get the volume CMS hoped for, either.

The GLP-1 BALANCE model has been paused because too few plans expressed interest.

BALANCE holds great promise, short-term costs in return for long-term savings and better health.

But it comes at a tough time for plans, which are in the midst of a financial recovery.

The Trump administration's vision is commendable but may need some tactical adjustment.

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

Medicare Advantage critics pound the program with shoddy analyses. We showcase the good ones on quality, value, and savings.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc pushes back on the Medicare Advantage critics, who pound the program with shoddy analyses. He showcases the good studies showing MA's quality, value, and savings.

Key Takeaways:

Medicare Advantage's critics pound the program with shoddy analyses.

But numerous studies show the quality, value, and savings in MA.

MedPAC's studies on MA's favorable selection are easily debunked as there is great evidence MA serves some of the most vulnerable.

So-called overpayments in risk adjustment have also been going away due to reforms.

Studies show that MA means much lower utilization among beneficiaries through managed care and care management.

Others show that enrollees in MA have much lower out-of-pocket costs.

Despite attacks by critics, still more analyses show overall lower per-beneficiary costs of MA compared with FFS.

MA also has a halo effect over overall Medicare spending.

The greater the MA penetration, the lower cost trends in Medicare as a whole.

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

The final 2027 Medicare Advantage Rate Announcement provided some relief to a still displeased industry.

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 space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the final 2027 Medicare Advantage Rate Announcement. It provided some relief to a still displeased industry.

Key Takeaways:

Medicare Advantage (MA) plans got a bit of relief from CMS initial proposal of a 0.09% rate hike in 2027.

The final adjustment will be 2.48%.

CMS gave in a bit to the industry and pulled back on another proposed risk adjustment model change.

It will follow through on some risk adjustment reform by barring unlinked charts (those not connected to an actual provider encounter) in most cases.

The rate hike is far below what has been seen in terms of utilization.

The hike will mean about $13 billion in new dollars to MA plans, up from under $1 billion proposed.

But because most plans do not have aggressive risk adjustment practices, most plans will see an increase closer to 4%.

Big plans will bear the burden of most of the unlinked chart reform.

The 2027 modest hike is yet another sign that CMS will be stingier on rate dollars in the future.

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