Legislative and Regulatory Options for Improving Medicare Advantage

Publication Title

Journal of Health Politics, Policy and Law

Authors

Erin C. Fuse Brown, Georgia State University College of LawFollow
Travis C. Williams, Georgia State University College of LawFollow
Roslyn C. Murray, University of Michigan School of Public HealthFollow
David J. Meyers, Brown University School of Public HealthFollow
Andrew M. Ryan, Brown University School of Public HealthFollow

Document Type

Article

Publication Date

2023

Abstract

The Medicare Advantage program was created to expand beneficiary choice and to reduce spending through capitated payment to private insurers. However, many stakeholders now argue that Medicare Advantage is failing to deliver on its promise to reduce spending. Three problematic design features in Medicare Advantage payment policy have received particular scrutiny: (1) how baseline payments to insurers are determined, (2) how variation in patient risk affects insurer payment, and (3) how payments to insurers are adjusted for quality performance. The authors analyze the statute underlying these three design features and explore legislative and regulatory strategies for improving Medicare Advantage. They conclude that regulatory approaches for improving risk adjustment and for recouping overpayments from risk-score gaming have the highest potential impact and are the most feasible improvement measures to implement.

Recommended Citation

Erin C. Fuse Brown, et al., Legislative and Regulatory Options for Improving Medicare Advantage, 48 J. Health Pol. Pol'y L. 919 (2023).

Institutional Repository Citation

Erin C. Fuse Brown, Travis C. Williams, Roslyn C. Murray, David J. Meyers & Andrew M. Ryan, Legislative and Regulatory Options for Improving Medicare Advantage, Faculty Publications By Year 3523 (2023)
https://readingroom.law.gsu.edu/faculty_pub/3523

DOI

10.1215/03616878-10852628

Volume

48

Issue

6

First Page

919

Last Page

950