My 2023 healthcare industry predictions are delivered with the assistance of clairvoyance, a … [+]
The year 2022 is almost behind us and the healthcare industry is preparing for what promises to be a most interesting 2023.
Deals—big and small—and increasing regulatory scrutiny will make 2023 a year to remember for all.
Given the prescience and accuracy of my 2022 predictions, many of you have asked about my methodology.
If you must know (and seek to remove the mystery of it all), it’s pure clairvoyance—a divine gift with which I was born.
Joking aside, some predictions are pure hunch; others are extensions of trends observed in 2022 that will continue into 2023; and others still are a reflection of my deepest hopes—some of which I hope I will nudge into being by writing it here in this column.
Without further ado, I give you the year ahead in healthcare, 2023 edition:
1) Medicare Advantage Will Remain Under A Microscope
Founding Centers for Medicare and Medicaid Innovation (CMMI) Director and former Trinity Healthcare … [+]
I predicted last year that that the Medicare Advantage debate that my mentors Don Berwick and Rick Gilfillan started in 2021 would intensify. The year 2022 didn’t disappoint as Don and Rick used the pages of the Health Affairs blog to spar with numerous Medicare Advantage defenders including heavyweights WellBe Medical CEO Jeff Kang, former Kaiser Permanente CEO George Halvorson, and former CAPG CEO Don Crane. New York Times writers Reed Abelson and Margot Sanger Katz followed on with a provocative set of articles on Medicare Advantage utilization management practices; revenue capture; and broker practices. The microscope is turned on and examining Medicare Advantage in high resolution—and this scrutiny will continue deep into 2023.
As the CEO of Medicare Advantage plans for 7 years running, I have strong conviction that the Medicare Advantage is an important program that enables innovation to serve older adults, but also acknowledge that there is significant room to improve it. To address some of the emerging skepticism of Medicare Advantage, plans should proactively implement more stringent revenue coding practices; commit to access-to-care “never events” to ensure beneficiaries always have access to care in a timely manner; and continue to enhance the quality of benefits delivered through their products. The best answer to the critics is to be irrefutably and consistently better for Medicare beneficiaries—and that is the challenge to all companies that operate plans.
Whether the pundits find value in the program or not, it is here to stay—as more than 40% percent of older adults rely on it for their care. Our focus should be on aligning on ideas to improve the program, not arguing whether it’s better or worse than traditional fee-for-service Medicare (as with most things, the answer is, it depends). The leadership of the Centers for Medicare and Medicaid
