How to Improve Health Insurance Practices

In my latest Forbes column, I propose five practical reforms that could enhance the Medicare Advantage program, making it more transparent, equitable, and effective for the seniors and communities it serves: 1) Pilot Mult-Year Enrollment in Plans. No matter what anyone says about their value-based care results, value is ill-produced in healthcare in one year increments. 2) Standardize Plan Benefits. Plans are competing on nonsense and unsustainable benefits—often leading to a bait and switch for seniors. Standardizing benefits will improve plan competition and ensure every plan delivers consistent and meaningful value. 3) Reform broker incentives, rewarding year-round member support—not just sign-ups. Effectively deployed, brokers can be the missing glue we need t improve American healthcare. 4) Vary maximum broker commissions with star ratings. Star ratings should be an accelerant to sales. Fact: Today, a good number of brokers will tell you they don’t even know plan star ratings when they sell them. 5) Drive adoption of capitated payments to align provider incentives toward coordinated, value-based care. Health systems have been snookered by health plans who non-transparently push off the costs of supplemental benefits and other expenses. This explains why so many health systems complain of underpayments while MEDPAC claims Medicare Advantage overpayments. There is a better way. Collectively, these reforms aim to improve the quality of the Medicare Advantage marketplace. As we collectively work toward building a more sustainable healthcare system, these are actionable steps that lawmakers, payers, providers, and advocates can take now. I invite you to read the full article and share your thoughts: how might these recommendations reshape Medicare Advantage—and what additional levers are we missing? https://lnkd.in/gQmevX5K

UnitedHealth’s surprising earnings miss and sharp stock decline have been blamed on rising costs in its Medicare Advantage business. But the real issue isn’t the government’s fixed payments. It’s how those dollars are used. Medicare Advantage may look like a modern payment system: insurers receive a fixed monthly payment per member, per month. But in reality, most insurers still pay doctors and hospitals based on the volume of care delivered, not the value. This creates the same broken incentives we see in traditional fee-for-service medicine: more procedures and more hospitalizations along with grossly insufficient focus on prevention and long-term health. That’s a costly mistake. Poorly managed chronic diseases like diabetes, heart failure and hypertension account for the majority of medical spending. When patients bounce between emergency departments and specialists, complications from chronic conditions (including heart attacks, strokes, cancers and kidney failures) rise dramatically and insurers pay the price. And, increasingly, so do investors. The solution? Capitation AT THE DELIVERY-SYSTEM (PROVIDER) LEVEL. That means doctors and hospitals are paid a fixed, risk-adjusted amount to keep people healthy—not to do more. This kind of payment structure rewards incentivizes prevention, effective chronic disease control and superior clinical outcomes, not just volume. This moment is a wake-up call for insurers like UnitedHealth. It’s time to invest in a better model. That means: ▶️ Multi-year agreements with health systems to pilot new care models ▶️ Risk-adjusted capitation—funding that matches patient needs and rewards healthier outcomes ▶️ Shared savings—dividing the financial gains when population health improves over time ▶️ Investment in generative AI to help patients and doctors manage chronic diseases in real time ▶️ Expansion of primary care to prevent illness rather than just hoping to reverse medical problems when they arise. UnitedHealth’s results are the canary in the coal mine. The status quo won’t hold. The good news? With the right incentives in place, we can save lives, lower costs and reduce clinician burnout. But only if we act now. #HealthcareonLinkedIn #UnitedHealth #UnitedHealthGroup #healthinsurance #medicareadvantage https://lnkd.in/gycAts2x

My latest from Forbes: Empowering Employers to Enhance Health Care Quality Employers hold immense potential to drive quality improvements in health care, which is vital for the well-being of their employees. With nearly half of Americans depending on employer-sponsored coverage, the responsibility to provide accessible, high-quality health benefits has never been more important. Yes, employers face challenges in pushing for quality and scaling innovations that can help. Currently, only 21% of commercial insurance payments incentivize improvements in health outcomes, a stark contrast to 43% in Medicare Advantage. This gap not only affects costs but also directly impacts the care and support our workers receive. Most employers are focused on their core business, not driving innovation in their benefits. To support increased employer focus on quality, Morgan Health, in partnership with JPMorgan Chase benefits, has established a roadmap that empowers employers to effectively measure and enhance health care quality through five key steps. A link to the Forbes piece is in the comments! 1. Identify Today’s Improvement Opportunities: Understanding the current health status of your employee population helps identify gaps in care quality. For instance, high levels of A1c among certain groups may lead to targeted goals to reduce diabetes prevalence. 2. Select Measures Based on Your Quality Goals: Determine what matters most for your workforce’s health. This could include reducing hospitalizations, enhancing access to preventive care, or improving provider satisfaction scores to ensure that employees are engaged in their health. 3. Determine Measure Baselines and Set Targets: Utilize national benchmarks, like those from NCQA Quality Compass, to establish baselines for key health indicators. This can guide you in measuring improvements against evidence-based expectations. 4. Establish Performance Payments that Incentivize Improvement: Align payment structures with quality improvement goals. Discuss and agree on fees-at-risk for performance targets to ensure accountability from health plans, providers, and vendors. 5. Document the Timeline and Process for Measuring Quality: Clearly outline how baselines are set and how results will be calculated. This not only promotes transparency but also helps in aligning all parties involved in the contract, especially when mitigating risks. Together, we can ensure that employers are equipped to foster a healthier workforce. Improving health care quality is not just beneficial—it’s essential for the health and happiness of our workers. Let's make quality care a priority! #HealthCare #QualityImprovement #EmployeeWellbeing #MorganHealth

Hear me out: Link insurance profits to improving outcomes. Value-based care, applied not BY payors, but TO them. Incentivizes opening up funding to public-health level interventions. If profits depended on all customers' health — not just individual claims — we’d see a whole different set of priorities. It wouldn’t be about squeezing every penny out of "medical loss" (which is a wild term if you think about it). Suddenly, it would make sense to invest in things like preventative care, social support, and upstream interventions. Things that don’t just reduce costs — they reduce suffering. Maybe we'd see insurance CEOs being as invested in housing stability or access to healthy food as they are in claim denials. And increasing therapist reimbursement because better mental health is so linked to better overall health. Not out of charity, but out of strategy. Because better health means better margins. Value-based care gets tossed around a lot, but it’s usually about controlling provider behavior. Flipping it onto payors forces them to act like actual stewards of public health, not just risk managers for shareholders. United Health Group's CEO is now calling for a system overhaul. This is the way. #insurance #communityhealth #overhaul