In this episode of Relentless Health Value, host Stacey Richter engages with Betsy Seals, CEO and co-founder of Rebellis Group, to analyze the future of key Medicare Advantage policies amidst a changing political landscape. They delve into four critical areas:

1. Medicare Advantage Stars Program: Examining potential changes due to recent lawsuits and the new administration’s stance on quality measures.

2. Risk Adjustment and Government Oversight: Discussing the focus on recouping improper payments and how oversight might evolve.

3. Use of Artificial Intelligence: Considering appropriate oversight for AI applications in prior authorization processes and ensuring they benefit patient care.

4. Agent and Broker Oversight: Exploring increased scrutiny over marketing practices and the dissemination of accurate information to beneficiaries.

Betsy emphasizes the importance for Medicare Advantage plans to prioritize patient value, maintain compliance, and proactively utilize data to navigate these evolving policies. This discussion provides valuable insights for stakeholders aiming to understand the future of Medicare Advantage.

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05:09 Will the Star Ratings program stay in this new administration?

08:08 How will the lawsuits against CMS policies play out with this new administration?

10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive?

16:22 How does AI directly impact beneficiary lives?

21:38 What’s going on now with the override payments?

27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward?

31:45 Why is it important to become more technologically savvy in compliance?