The Shift from Medicare to Medicare Advantage 

A Shift From Traditional Medicare: Increase in Medicare Advantage Beneficiaries  

In 2024, we expect there will be higher adoption and enrollment rates for Medicare Advantage (MA) that continue to surpass traditional Medicare due to the growing trend among patients opting for Medicare Advantage over the traditional red, white, and blue Medicare. The percentage of total MA patients has increased from 32% in 2015, when CCM was established, to over 51% at present. This indicates that healthcare providers need a reliable partner or solution to effectively incorporate these patients into their programs. 

Medicare Advantage and ACOs  

The shift could have an impact on ACO assignment and attribution, as ACOs could lose their “high-value” patients to MA plans. This much movement can also lead to billing headaches, which is why CareHarmony implements an End of Year Annual Assessment. The assessment essentially functions as a virtual annual wellness visit which allows us to identify any payer changes and communicate this with our clients. It’s a chance to update records and prevent billing denials going into the next calendar year. We also utilize this as an opportunity to analyze any positive or negative trends.  

Positive Aspects of the Medicare Advantage Shift  

The shift to Medicare Advantage doesn’t necessarily have to be negative. Many MA plans are embracing FFS programs and, in some cases, the reimbursement rates can be considerably higher than traditional Medicare. While many groups have typically limited their program to traditional Medicare patients, CareHarmony encourages potential expansion into MA plans as this trend continues. Gaining an understanding of the rules and requirements associated with these plans takes diligence, but can prove to be a worthwhile investment as this is most likely the beginning of a larger shift toward MA plans. Note: As the shift from traditional Medicare to Medicare Advantage continues, some groups may consider moving into a capitation model, which is unable to monetize the traditional preventative care billing codes. Due to our proven track record of success in delivering outcomes under the ACO model, CareHarmony is advancing into a new phase in which we will now assume risk along with our clinical partners in a capitation environment 

Source: Nancy Ochieng, Jeannie Fuglesten Biniek, Meredith Freed, Anthony Damico, and Tricia Neuman. (2023) Medicare Advantage in 2023: Enrollment Update and Key Trends, KFF 

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