Reimbursement system is broken, insurance CEO says


The health insurance payment system is broken and the Affordable Care Act, which was supposed to lower costs, is actually contributing to the problem, MVP Health Care CEO Denise Gonick, told the Albany Business Review

Because of issues like new taxes, government spending cuts and the ACA's shift to value-based care, insurers actually are spending more money just to sustain their plans, especially those in the Medicare Advantage program, mentioned Gonick, who also serves as president of the Schenectady, New York-based insurer. 

"In the long run, we don't think that is a recipe for success," she said, adding that although many insurers are moving toward value-based reimbursement that focuses more on quality, transparency and accountability, the ACA doesn't sufficiently compel that shift.

In fact, a recent federal report urged insurers to speed up the adoption of value-based reimbursement so the entire industry can implement systems-engineering principles that will boost efficiency of care.

Gonick blamed federal cuts to the Medicare Advantage program as the chief reason MVP Health Care just announced that it's discontinuing two of its five Medicare Advantage plans, impacting almost 20,000 consumers, FierceHealthPayer previously reported.

"This discontinuation is a real problem. Frankly, it is not fair to our seniors," she told ABR. "We're left with this system where you're experiencing the revenue reductions without some of the benefits."

Meanwhile, MVP Health Care and other insurers are forced to cut jobs and adjust their plans as a way to save money until a value-based system is firmly implemented across the industry.

To learn more:
- read the Albany Business Review article

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