New research calls for transparency in Medicare Advantage operations
New INFORMS Journal Manufacturing & Service Operations Management Study Key Takeaways:
As Medicare Advantage (MA) beneficiaries become sicker, health plans spend disproportionately less on their care relative to the payments received, with evidence suggesting this is partially due to illegal strategic cross-subsidization.
For each one-point increase in a patient’s risk score, their annual “spending-cost difference” (the gap between what MA plans spend on a patient vs. what they receive in payments) decreases by more than $9,000.
Strategic cross-subsidization could exacerbate socioeconomic inequalities in healthcare access and outcomes.
Rigorous oversight ...











