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Editorial

The good, bad and ugly in Medicare Advantage

John Gorman, Gorman Health Group

In the last few weeks there's been good, bad and ugly news for Medicare Advantage (MA) plans. On one hand, the program has never been stronger and quality metrics are surging in the right direction; on the other, the industry is sucking it up on following the rules of its biggest customer, the Centers for Medicare & Medicaid Services.

Still using horses and buggies

Paul Levy

I recently had to reschedule a routine exam with my hospital-based primary care doctor and so decided to use the supposed rescheduling functionality on the patient portal to carry out this task. 

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President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.

 

Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

For now at least, the employer mandate isn't going anywhere. But small businesses are flocking to a new market, leaving behind traditional models.

Every organization looking at someone else's business thinks there is a tremendous amount of waste, and believes they could do it better if given the opportunity. This is just as true in healthcare as any other industry.

Many health insurers have spent close to a century operating under fee-for-service and are now changing course. Some new payers founded post-health reform, however, are trying to hit the value-based ground running.

Of all the things to try to build a better business for in healthcare, the nation's fourth-largest Blue Cross insurer is focusing on one of life's most crucial processes.

Encouraging employer programs for health and prevention with one hand, the federal government is trying with the other hand to stake out a limit to what can be required of employees. And it's getting a bit fractious in the wellness space.

UnitedHealth continued its shopping spree on Tuesday with Optum, the group's technology and services subsidiary, agreeing to pay $600 million to acquire Alere Inc.'s condition management and wellness subsidiaries.

The raison d'etre and central function of health insurers has had a slow time coming into the 21st century. But with both providers and patients demanding a better experience, the impetus for progress could bring a critical mass.

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