Course
Medicare Advantage
The largest risk-bearing arrangement in American healthcare, now covering a majority of Medicare beneficiaries: how plans are paid through bids and rebates, risk adjustment and coding intensity, Star Ratings and the litigation reshaping them, prior authorization and benefits, and what MA actually delivers.
By the end of this course, you will be able to:
- Explain how bids, benchmarks, and rebates determine what an MA plan is paid and what enrollees receive
- Describe how Star Ratings raise both the benchmark and the rebate share, and why that compounds
- Assess coding intensity and the audits and litigation that address it
- Evaluate the rules that now constrain prior authorization and utilization management in MA
- Weigh what Medicare Advantage delivers to beneficiaries against what it costs the program
How Medicare Advantage Works
MA now covers a majority of Medicare beneficiaries. How plans are paid through benchmarks, bids, and rebates, and how the quality bonus lifts the whole formula.
Risk Adjustment in MA
Risk scores multiply payment for 35 million people. How the model works here, what coding intensity costs, and how audits and courts are reshaping enforcement.
Star Ratings
One composite score decides billions in bonus and rebate dollars. How stars are built, the behavior that follows, and the litigation that has destabilized them.
Utilization Management and Benefits
Prior authorization, networks, and supplemental benefits: the tools that define the member experience, and the rules that now constrain them.
MA and Value-Based Care
Where MA meets provider risk: global capitation delegated to physician groups, how MA compares to traditional Medicare accountable care, and an honest scorecard.