Value-Based Care Insights New Episode NOW On-Demand
Medicare Advantage (MA) continues to grow and reshape the healthcare landscape, with CMS projecting that 34 million people, approximately 47% of Medicare beneficiaries, will be enrolled in MA plans in 2027. At the same time, financial pressures, rising denial rates, administrative complexity, and changing risk models are creating new challenges for health plans and providers alike.
On this episode host Daniel J. Marino welcomes Cliff Frank, President and Founder of Healthcare Management Solutions, to examine the forces shaping Medicare Advantage as organizations prepare for 2027. With more than 30 years of experience in payer strategy, managed care contracting, and provider relationships, Cliff shares his perspective on the struggle to protect margins while navigating an increasingly complex reimbursement environment.
For healthcare executives, physician groups, and clinically integrated networks, this conversation highlights the importance of evaluating payer partnerships, aligning financial incentives with clinical outcomes, and developing sustainable strategies for succeeding in Medicare Advantage.
Key Takeaways:
- Rising denials, administrative burdens, and margin pressure are changing the economics of Medicare Advantage for providers.
- Success under risk-based arrangements depends on embedding accurate documentation and effective care management into clinical workflows.
- Healthcare leaders should assess payer relationships, site-of-service opportunities, and value-based performance to build a sustainable Medicare Advantage strategy.
About The Show
Value-Based Care Insights is a radio show on Healthcare NOW Radio, that explores how to optimize the performance of programs to meet the demands of an increasing value-based care payment environment. It is hosted by Dan Marino (@DjmarinoHD) and highlights recognized experts in the field and within Lumina Health Partners (@LuminaHP).
Tune in weekdays at 5:00am, 1:00pm and 9:00pm ET.
Follow the Social Hashtag at #VBCInsights.