Nearly half of all health systems are dropping Medicare Advantage plans.

The healthcare landscape is being tested as mounting challenges with Medicare Advantage plans stir significant concerns among health systems nationwide. A revealing report by the Healthcare Financial Management Association and Eliciting Insights, stemming from a survey of 135 health system CFOs, indicates a brewing storm. An eye-opening 16% of health systems are poised to halt acceptance of certain Medicare Advantage plans within the next two years, with another 45% teetering on the brink of the same decision.

The tension highlights a growing dissatisfaction, with Chris Van Gorder, president and CEO of Scripps Health, vocalizing a common frustration, likening interactions with Medicare Advantage to a “game of delay, deny, and not pay.” Scripps Health’s decisive action to terminate its Medicare Advantage contracts, affecting over a thousand physicians, underscores the financial strain, marked by a staggering annual loss of $75 million on these contracts.

The sentiment echoes across the sector, with Kurt Barwis, CEO of Bristol Health, attributing significant job cuts directly to the unsustainable economics driven by inadequate Medicare Advantage reimbursements. This growing disillusionment with the model is met with cautionary words from Sachin Jain, MD, CEO of SCAN Group, who warns of the potential backlash against health systems for abandoning plans crucial to low-income populations.

Don Berwick, MD, a former CMS Administrator, encapsulates the crux of the issue as a “manifestation of an underlying broken system,” spotlighting the inherent conflict between the desire to provide care and the pressure to minimize costs. Despite the program’s high satisfaction ratings among enrolled members, the reality for those needing care tells a different story, with narratives of denied claims and the daunting challenge of securing MediGap coverage after leaving a Medicare Advantage plan illuminating a critical gap in patient support.

The voices of healthcare professionals and patients alike reveal the complex, often distressing journey through the Medicare Advantage landscape, marked by bureaucratic hurdles that obscure the path to care and compensation. This scenario unfolds against a backdrop of a healthcare system in flux, compelling a critical examination of Medicare Advantage’s role in the broader healthcare ecosystem and a call for actionable solutions to mend a fragmented system.