I don’t know about you but I'm FASCINATED with Medicare Advantage (MA). Massive growth, fueled by its shrewd marketing of added benefits beyond traditional Medicare. But also chaotic, messy, a program in need of reining in.

It’s a bit of the wild west.

I like some things about MA, including its emphasis on preventative care and aligning patients outcomes with rewards. But I'm also routinely disappointed by its excesses and denial of medically necessary care.

Some days MA seems poised to overtake and end traditional Medicare. But every time I think that, another shoe drops. Intensive audits from the OIG, and sharp criticism from the likes of former CMS administrator Don Berwick. Two weeks ago we saw the nation’s largest ACO get hit with a whistleblower lawsuit for alleged upcoding abuses.

To get a big picture overview and figure out where we are with the program I invited 4Sight Health’s David Burda to join me on the podcast. David is 4SightHealth’s news editor and columnist and hosts a podcast, the 4sighthealth roundup, covering MA and other adjacent topics.

Listen in as we discuss:

• David’s journalism background and eventual path into covering healthcare

• MAs rapid adoption: Will it continue until Medicare is phased out—or is a reckoning coming?

• The problems with MA: Gaming of risk adjustment/upcoding to make patients appear sicker, denial of medically necessary care, prior authorization nightmares, and sky-high insurer profits

• What MA is doing well, should be preserved, and what needs reform

• Is healthcare compatible with a free-market economy and shareholder ROI? 

• How David stays on top of the torrent of healthcare news, and his cool addition to the #OTR Spotify playlist

Additional reading from 4sighthealth:

• What Will Happen to Traditional Medicare? https://www.4sighthealth.com/ken-terry-what-will-happen-to-traditional-medicare/ 
• Spy vs. Spy? More Like Medicare vs. Medicare Advantage https://www.4sighthealth.com/spy-vs-spy-more-like-medicare-vs-medicare-advantage/