Module 5
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.
By the end of this module, you will be able to:
- Describe how global risk arrangements transfer capitation from plans to physician groups
- Compare accountability in MA with accountability through traditional Medicare ACOs
- State an evidence-based verdict on what MA delivers and what it costs
- Delegated Risk MA plans pass capitation down to physician groups. This lesson covers global risk, the deepest provider risk arrangement in American healthcare. About 5 min
- Two Roads to Accountability Medicare now runs two competing theories of value: private plans and traditional-Medicare ACOs. This lesson compares them. About 4 min
- Medicare Advantage: An Honest Scorecard The capstone: what Medicare Advantage actually delivers, for beneficiaries and for taxpayers, read without spin. About 5 min
Module quiz
Answer all questions to see your score.
1. In a global risk arrangement, what does a physician group receive?
The group becomes functionally an insurer for its panel, gaining autonomy from plan utilization management and taking on an insurer's requirements.
2. What is the core structural difference between MA and traditional Medicare ACOs?
They fail differently: MA toward restriction and higher program cost, ACOs toward modest effect, which is why policy has kept both.
3. What is the most defensible summary of MA's overall record?
Both halves are true at once; the policy question is whether the added spending buys enough added value.