Despite uncertainty about what a second term under President-Elect Donald Trump will mean for several aspects of health care, Medicare Advantage plans may find themselves in a better position with the new administration.
In recent years, Medicare Advantage has faced scrutiny by the Senate Finance Committee over prior authorization denials and misleading marketing of plans and enforcement actions by the Office of Inspector General for noncompliance. That may change if the new Trump administration lifts some restrictive policies governing Medicare Advantage.
In anticipation of a more favorable environment, shares of some of the biggest Medicare Advantage carriers surged in the wake of last week’s election results, S&P Global reports that United Health Group Inc’s stock price grew 5.1 percent between November 1 and November 6, and its shares increased $567.56 to $596.69 a share. Humana stock increased 10.7 percent during that same period and its shares jumped from $260.71 to $288.51 a share.
Although health policies weren’t a huge topic for Trump during the election cycle, the Heritage Foundation’s Project 2025 may offer clues into how the administration will view the privatization of Medicare. Trump did distance himself from the Project 2025 during the campaign, but many of the authors and coalitions groups that worked in the first Trump administration were involved in drafting the report and may advise Trump in his second term.
The 900-plus page document calls the reintroduction and restoration of policies that the Biden administration withdrew or weakened. The plan urges critical reforms to strengthen and improve Medicare Advantage, including making the program the default enrollment option, remove burdensome policies that micromanage Medicare Advantage policies, and to reconfigure the current risk adjustment model.
Trump’s campaign website also promoted Medicare Advantage. He said he would prioritize home care benefits by shifting resources back to at-home senior care and build on his actions during his first term, providing new Medicare Advantage supplemental benefits.
But that doesn’t mean Medicare Advantage won’t face challenges. Health plans will need to face regulatory requirements and focus on innovation, noted Bill Georges, a partner and executive-in residence at AlleyCorp, a venture capital firm, in an article for MedCity News.
“The market opportunities for Medicare Advantage remain vast, but only for those willing to evolve,” he wrote. “Now is the time for health plans to step up and embrace the tools and strategies that will not only meet regulatory demands, but also drive innovation in care delivery."
It’s a similar message that industry experts who will speak at the upcoming RISE Star Ratings Master Class told RISE during a recent interview. Ana Handshuh, principal, CAT5 Strategies, said Medicare Advantage plans that succeed in Stars are leaders in innovation. Continuous improvement is imperative now, she said. Plans must become nimble and adaptable.
Rex Wallace, CEBS, chief executive officer of Rex Wallace Consulting, LLC., will speak during a session featuring how health plans use innovation internally to improve their Star ratings. “Some plans put guardrails on what they call innovation and that prevents them from being able to budget like they could for innovation,” he told RISE. “There are a lot of ways plans can learn to innovate more effectively and we believe it correlates directly to their Stars performance.”