August 31, 2025 • 16 mins
Welcome back to the Value-Based Care Advisory podcast! In this episode, host Alex Yarijanian delves into the significant updates and strategies for 2026 in the Medicare Advantage space. He covers essential news and policy changes, including a 5% increase in Medicare payment rates, the scaling back of supplemental benefits, and the permanence of telehealth for behavioral health. Alex also discusses updates to the Medicare physician fee schedule, redesigned enrollment forms, new health risk assessment requirements, and the transition to a new risk adjustment model. Learn how these changes will impact care delivery, compliance, and strategy, and discover what it takes to thrive in this evolving landscape. Tune in and prepare for the Medicare Advantage showdown of 2026!
00:00 Welcome to the Value-Based Care Advisory Podcast
00:15 2026 Medicare Advantage Showdown Overview
01:24 Key Policy Updates for 2026
03:11 Telehealth and Virtual Care Innovations
04:39 Enrollment and Form Updates
06:12 Risk Adjustment and Star Ratings
08:52 Strategic Focus Areas for 2026
14:44 Final Thoughts and Conclusion
Takeaways:
- The 2026 Medicare Advantage payments are set to increase by approximately 5%, contributing an excess of $25 billion to the plans.
- Significant changes have been initiated regarding supplemental benefits, particularly affecting non-medical services like transportation and meals.
- Telehealth services for behavioral health will become a permanent fixture, with no geographic restrictions imposed from 2026 onward.
- New billing codes will be introduced for digital therapeutics and remote monitoring, enhancing the infrastructure for virtual care delivery.
- The upcoming risk adjustment model will utilize the full 2024 CMS HCC risk model, significantly impacting financial strategies for Medicare Advantage organizations.
- Plans must prioritize compliance and operational integrity to navigate the complexities of changing regulations and maintain their competitive edge.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome back to the ValueBased Care Advisory Podcast.
I'm your host, Alex Arijanianand I see many of you listening in,
tuning in from different partsof the world and certainly the United
States.
And I don't know who you are,but I welcome you to this space.
So today's episode is allabout 2026 Medicare Advantage showdown.
(00:22):
Again, this is a niche podcast.
This is where I share guidanceand insights that I share with clients
on calls.
Of course they pay.
And then I wonder about allthe others who don't have access
to me, who don't have accessto the capital or the resources to
secure this type of businessconsulting, this type of go to market
(00:44):
leadership and guidance.
So today I want to share itwith you.
I want to share with youwhat's coming 2026 in the Medicare
space.
That's the year when paymentrules, virtual health and stars align.
And I don't mean stars in theuniverse or the terrestrial stars,
(01:05):
I mean Medicare star ratings.
All of these align and collidein ways that will decide who wins
and who falls behind inMedicare Advantage.
So the question you have toask if you want to listen any further
here is are you going to win?
So if the answer is yes, keep listening.
So I'm going to first give yousome news and policy updates for
(01:26):
2026.
Number one really is theMedicare payment rates jump.
So CMS announced that final2026 payments are up about 5% beyond
the initial 2% that was proposed.
So that's over $25 billionadditional dollars to Medicare Advantage
plans.
This has already spiked majorinsurer stock gains.
(01:48):
And it matters because moremargin means more flex.
Insurers can reinvest innetwork benefits quality if they
choose wisely.
Another is supplementalbenefit pullback.
So I don't know if you heard,but CMS is tightening the scope for
sspci.
So that's a specialsupplemental benefit for the chronically
(02:09):
ill. Those will be scaleddown, they'll be separated.
Scaling back non medicalbenefits, which is, to be honest,
sad.
I'm just giving you a policyupdate and I'll add some editorial
in there.
Scaling back benefits likemeals, transportation, over the counter
items, it's not a disruptionso much as a squeeze on the edges,
right?
(02:29):
Because it's not like you havemass delivery of these services anyway.
And now you can kind of seewhy, right?
Those who take risks andimplement these types of delivery
systems and deliver meals andtransportation are still finding
a lack of reliance andstability in terms of how these supplemental
benefits are going to be administered.
(02:50):
Moving forward and it mattersbecause it forces leaders to focus
marketing not on shiny perks,but on core value.
Core value, networks, meds, outcomes.
So if you're in that space,your partnership prospects look like
they need some attention forthe coming year.
Think about it now.
(03:11):
Telehealth, the big thing.
Telehealth for behavioralhealth becomes permanent.
Okay, so virtual health issticking around permanent coverage,
no geographic restrictions andno requirement for an in person visit
starting 2026 for FQHCs andRural Health clinics, federally qualified
(03:33):
health care centers and ruralhealth clinics.
And it matters.
It matters because MedicareAdvantage payers will continue to
lean into virtual behavioralhealth, making it a standard, not
a supplement.
Next, I want to share howvirtual care wins in fee schedule.
So the 2026 Medicare physicianfee schedule expands virtual care
(03:56):
even beyond behavioral.
So I'm talking about digitaltherapeutics for adhd, updates to
the diabetes preventionprogram and, and new codes for remote
monitoring.
All of these are on deck.
And this is important.
It matters to you.
It matters because theinfrastructure for virtual primary
and chronic care is getting stronger.
MA plans that support andintegrate these innovations will
(04:18):
stand out.
And it's, it's your role tostand yourself out.
You have to understand, plansare dealing with thousands of thousands
of network participants right now.
How are they going to pick and choose?
How are you going to putyourself in front of the Medicare
Advantage plans at the righttime, at the right place, with the
right messaging to get theright type of deal?
(04:39):
I want to inform you of somepaperwork related stuff, so enrollment
and form updates.
CMS is rolling out aredesigned Medicare Advantage Part
D enrollment form.
So before you start fallingsleep behind the wheel, what they're
going to do is they're goingto remove optional demographics like
race, ethnicity, sexualorientation, gender identity.
A little editorial here isthat, you know, initially when all
(05:02):
this information was startingto be collected, it was added one
by one.
So first it was race, thenthey came back and added ethnicity.
Sometime later they addedsexual orientation.
Then they added genderidentity, which, you know, it's great
to collect data, but I thinkit sucks that race and ethnicity
have to now go because thislist was so long to begin with.
(05:23):
So that's upsetting to me.
To remove optionaldemographics like race and ethnicity
is.
It's optional, but folks stillhave the option of reporting.
And it's something we want to know.
And it matters because itmight streamline enrollment and it
also signals shiftingpriorities around this equity topic,
(05:47):
dei, et cetera.
But there is nothing thatmakes sense in terms of, hey, you
don't know what risk strata toput your enrollees because you do
consider race, ethnicity.
Yeah.
Also sexual orientation,certain instances into your risk
modeling.
So a plan could perform betterif they have better insight into
(06:08):
the population, even though ifit is optional.
STAR ratings and health riskassessment rollouts.
So we've been talking aboutthis since the aca, AKA Obamacare
was being implemented and Iwas director of managed care at these
community clinics and theclock was turning, the law was about
(06:28):
to be implemented.
So we're still talking abouthow to do health risk assessments.
Truly, it's like theequivalent of lacking high speed
rail in the United States.
It's moving very, very slowly.
And so I'm going to announcethat starting October 2026, RAs will
be required for enrollmentdates in 2027.
(06:52):
So new breast cancer screeningmeasures will be counted in 2029.
Are you with me?
So do you do understand thatwhen it says starting 2026 that means
the health plans are right nowat the, in, in August of 2025 wrapping
up deals to make that happenor thinking about how they're going
to make it happen?
(07:13):
Now the question is, will youpop up at the right place at the
right time and let them knowhow you plan to help the Medicare
Advantage organization makethis happen?
Why does it matter?
Why does it matter?
DJ it matters because thesemeasures re emphasize preventative
metrics as the benefits scopeshrink elsewhere.
(07:33):
So as we're seeing shrinkagein the non medical services, we're
seeing good expansion herewith good old preventative metrics.
And seven because I like thenumber seven sometimes although I
like eight better is riskadjustment is fully transitioning
now.
Fully transitioning.
(07:54):
So it's been in transition.
And when I read this from thecms, I remembered how it's been transitioning
for some time now, is nowusing the full 2024 CMS HCC risk
model, whatever that means.
Right.
I mean it's complicated.
They're updating algo, et cetera.
The point of this podcast istell you how that works, especially
if you're driving.
(08:14):
But what happens is that itbrings you $12.9 billion in savings
to particularly trust fundwhich as a millennial, I'm very much
for that trust fund being preserved.
Of course $12.9 billion is nota whole lot, right?
But the Medicare Advantageorganizations could use some mitigation
(08:37):
in terms of how much riskadjustment they get retro and moving
forward.
So again, while the details ofthis I do not know if you are into
providing the HCC riskmodeling for plants, this is something
you should Be reading, sendme, tell me your notes.
All right, so I'm going tofocus on three.
Why don't I focus on threeareas that I just talked about and
(09:01):
delve a little bit deeper andbring you some food for thought.
Okay, so what did I say at thebeginning of this podcast?
I said what CMS just changedfor 2026.
I talked about 5% boost inMedicare Advantage payments for 2026.
That is a $25 billion flowinto health plans.
(09:26):
This is higher than theoriginal proposal.
I know some of you might haveheard, you know, earlier this year,
MA plans are getting a boost, etc.
Now we know it's a 5% boostand stocks for these insurance companies
jumped overnight when this was announced.
So let's be clear that moneydoesn't automatically make it to
(09:46):
providers or innovators.
Okay, you're not getting a $25billion check at least yet.
It's a margin opportunity andhow it's deployed will decide who
thrives.
But first you decide if youthrive and then how you deploy this
margin opportunity will be thedecisive factor in your performance
(10:09):
in 2026.
Remember, at the same time,CMS is tightening the belt on supplemental
benefits perks like meals,over the counter, transportation,
all of these are being scaled back.
So what I want you to thinkabout also is that if you had a strategy,
if you're one of these stateswhere you said, let's say California,
(10:29):
where you do get paid for nonmedical services like meals under,
for instance, the Calaimprogram and so on, you would have
been smart to couple that withyour Medicare supplemental benefit
programs.
Now would you have, I mean,you know, conf figured how those
(10:51):
would be rolled backpotentially because they, they're
optional supplemental benefits.
OSP.
They're not MSPs, those aremandatory supplemental benefits.
So the message is simple.
Benefits should be connectedto outcomes, not just marketing fluff.
We don't want to see marketing fluff.
And I'm glad that CMS isactually putting in mechanisms to
(11:14):
reduce that.
And then I told you about therisk adjustment.
I want to talk about virtualcare here.
The most important changereally is that behavioral telehealth
is being made permanent.
No geographic restrictions.
This really cements behavioralhealth as one of the pillars of Medicare
Advantage strategy.
But that's not all.
That's not all.
Remember I told you about newbilling codes available I was sharing
(11:37):
with DJ earlier.
These new billing codes updatethe Diabetes Prevention program model,
which probably we should do anepisode on.
And they provide new codingfor remote monitoring.
So CMS isn't just dipping itstoe in the water.
If you need a translation.
Okay.
It's building the pipes fordigital health.
Building the delivery systemfor digital health.
You know that the presidentadministration is very forward on
(12:02):
digital is very forward onkind of looking outside the box.
Okay.
So if you're a provider group,a health plan startup, my question
is this.
Are you treating virtual carelike a bolt on or are you backing
it into the core of your care model?
Because in 2026 virtual isn'tan experiment, it's table stakes.
(12:26):
If you're virtual only youhave challenges.
If you're brick and mortaronly you have challenges.
What is your hybrid strategynow that's going to lead into.
I'm going to tell you whatpayers really want in 2026.
What are they looking for?
Efficient care delivery.
What does that mean?
(12:48):
Do the thing that you need todo to get the outcomes that is desired
and do it in a way that isteam based as virtual first, that
has boots on the ground.
Next is your compliance muscle.
The risk model shifts makestop making documentation and coding
audits more critical than ever.
(13:09):
Plans don't want partners whoare creative with coding.
Don't get creative.
There's get creative withother things.
They want partners who are bulletproof.
So please scale it down withthe excessive PowerPoint slides talking
about numbers that havenothing to do with that particular
client or prospect.
The MA plan.
(13:30):
What is your digital memberengagement strategy?
Seniors are switching plans athigher rates.
So if I'm Humana and mypatients, my seniors are leaving.
Well I'm going to like if Ihear a solution that keeps members
loyal, simplifying benefits,reducing surprise costs and using
digital channels to build trust.
(13:51):
Next is Star performance.
Every operational leader istied back to stars and with new measures
like breast cancer screeningbeing phased in.
Are you a forward looking provider?
Are you building processesthat now now to stay ahead?
Are you building processes tobe ahead?
Think about it.
Are you building process toaccommodate current chaos?
(14:16):
And last is scalability.
It's a word that's been thrownaround, it's lost its shine.
Scalability is for instancewhether it's forms, health risk assessments,
prior auth changes,contracting, network management,
etc.
Health plans want partners whocan adapt quickly without breaking
operations.
(14:37):
We're not looking to disrupt,we're looking to facilitate.
We're looking to enhance.
So this is where I stand youguys, this is where I land.
The 2026 showdown in MedicareAdvantage is about focus and execution.
Yes, there's more money flowing.
Yes, virtual care is becoming permanent.
But the winners won't be theones trying to do everything.
(15:00):
The winners will be these people.
One they're nailing risk adjustment.
They're getting what it meansby compliance.
They have world class star operations.
They use virtual health not asa perk, but as a backbone of care
delivery.
And they don't rely just on virtual.
Seniors don't care about CMSmemos or risk models.
Right.
They care about trust,clarity, outcomes, how they feel
(15:24):
when they interact with that system.
Are they further relaxed or dothey feel tension?
Do they feel cared for or dothey feel abandoned?
If you get that right, therevenue flows and it will flow.
I just told you the sum isabout to be flowing.
So here's your challenge in 2026.
Pick your battleground.
(15:44):
What will it be?
Will it be stars?
Virtual care?
Documentation, integrity?
Whatever it is, commit, investand execute at the world class level,
standardized with your payer partners.
Because this is not justanother year in Medicare Advantage.
It is a turning point.
(16:04):
And with that, I'm AlexArijanian and this has been the Value
Based Care Advisory podcast.
Thanks for tuning in and I'llsee you next time.
Welcome back to the ValueBased Care Advisory Podcast.
I'm your host, Alex Arijanianand I see many of you listening in,
tuning in from different partsof the world and certainly the United
States.
And I don't know who you are,but I welcome you to this space.
So today's episode is allabout 2026 Medicare Advantage showdown.
(00:22):
Again, this is a niche podcast.
This is where I share guidanceand insights that I share with clients
on calls.
Of course they pay.
And then I wonder about allthe others who don't have access
to me, who don't have accessto the capital or the resources to
secure this type of businessconsulting, this type of go to market
(00:44):
leadership and guidance.
So today I want to share itwith you.
I want to share with youwhat's coming 2026 in the Medicare
space.
That's the year when paymentrules, virtual health and stars align.
And I don't mean stars in theuniverse or the terrestrial stars,
(01:05):
I mean Medicare star ratings.
All of these align and collidein ways that will decide who wins
and who falls behind inMedicare Advantage.
So the question you have toask if you want to listen any further
here is are you going to win?
So if the answer is yes, keep listening.
So I'm going to first give yousome news and policy updates for
(01:26):
2026.
Number one really is theMedicare payment rates jump.
So CMS announced that final2026 payments are up about 5% beyond
the initial 2% that was proposed.
So that's over $25 billionadditional dollars to Medicare Advantage
plans.
This has already spiked majorinsurer stock gains.
(01:48):
And it matters because moremargin means more flex.
Insurers can reinvest innetwork benefits quality if they
choose wisely.
Another is supplementalbenefit pullback.
So I don't know if you heard,but CMS is tightening the scope for
sspci.
So that's a specialsupplemental benefit for the chronically
(02:09):
ill. Those will be scaleddown, they'll be separated.
Scaling back non medicalbenefits, which is, to be honest,
sad.
I'm just giving you a policyupdate and I'll add some editorial
in there.
Scaling back benefits likemeals, transportation, over the counter
items, it's not a disruptionso much as a squeeze on the edges,
right?
(02:29):
Because it's not like you havemass delivery of these services anyway.
And now you can kind of seewhy, right?
Those who take risks andimplement these types of delivery
systems and deliver meals andtransportation are still finding
a lack of reliance andstability in terms of how these supplemental
benefits are going to be administered.
(02:50):
Moving forward and it mattersbecause it forces leaders to focus
marketing not on shiny perks,but on core value.
Core value, networks, meds, outcomes.
So if you're in that space,your partnership prospects look like
they need some attention forthe coming year.
Think about it now.
(03:11):
Telehealth, the big thing.
Telehealth for behavioralhealth becomes permanent.
Okay, so virtual health issticking around permanent coverage,
no geographic restrictions andno requirement for an in person visit
starting 2026 for FQHCs andRural Health clinics, federally qualified
(03:33):
health care centers and ruralhealth clinics.
And it matters.
It matters because MedicareAdvantage payers will continue to
lean into virtual behavioralhealth, making it a standard, not
a supplement.
Next, I want to share howvirtual care wins in fee schedule.
So the 2026 Medicare physicianfee schedule expands virtual care
(03:56):
even beyond behavioral.
So I'm talking about digitaltherapeutics for adhd, updates to
the diabetes preventionprogram and, and new codes for remote
monitoring.
All of these are on deck.
And this is important.
It matters to you.
It matters because theinfrastructure for virtual primary
and chronic care is getting stronger.
MA plans that support andintegrate these innovations will
(04:18):
stand out.
And it's, it's your role tostand yourself out.
You have to understand, plansare dealing with thousands of thousands
of network participants right now.
How are they going to pick and choose?
How are you going to putyourself in front of the Medicare
Advantage plans at the righttime, at the right place, with the
right messaging to get theright type of deal?
(04:39):
I want to inform you of somepaperwork related stuff, so enrollment
and form updates.
CMS is rolling out aredesigned Medicare Advantage Part
D enrollment form.
So before you start fallingsleep behind the wheel, what they're
going to do is they're goingto remove optional demographics like
race, ethnicity, sexualorientation, gender identity.
A little editorial here isthat, you know, initially when all
(05:02):
this information was startingto be collected, it was added one
by one.
So first it was race, thenthey came back and added ethnicity.
Sometime later they addedsexual orientation.
Then they added genderidentity, which, you know, it's great
to collect data, but I thinkit sucks that race and ethnicity
have to now go because thislist was so long to begin with.
(05:23):
So that's upsetting to me.
To remove optionaldemographics like race and ethnicity
is.
It's optional, but folks stillhave the option of reporting.
And it's something we want to know.
And it matters because itmight streamline enrollment and it
also signals shiftingpriorities around this equity topic,
(05:47):
dei, et cetera.
But there is nothing thatmakes sense in terms of, hey, you
don't know what risk strata toput your enrollees because you do
consider race, ethnicity.
Yeah.
Also sexual orientation,certain instances into your risk
modeling.
So a plan could perform betterif they have better insight into
(06:08):
the population, even though ifit is optional.
STAR ratings and health riskassessment rollouts.
So we've been talking aboutthis since the aca, AKA Obamacare
was being implemented and Iwas director of managed care at these
community clinics and theclock was turning, the law was about
(06:28):
to be implemented.
So we're still talking abouthow to do health risk assessments.
Truly, it's like theequivalent of lacking high speed
rail in the United States.
It's moving very, very slowly.
And so I'm going to announcethat starting October 2026, RAs will
be required for enrollmentdates in 2027.
(06:52):
So new breast cancer screeningmeasures will be counted in 2029.
Are you with me?
So do you do understand thatwhen it says starting 2026 that means
the health plans are right nowat the, in, in August of 2025 wrapping
up deals to make that happenor thinking about how they're going
to make it happen?
(07:13):
Now the question is, will youpop up at the right place at the
right time and let them knowhow you plan to help the Medicare
Advantage organization makethis happen?
Why does it matter?
Why does it matter?
DJ it matters because thesemeasures re emphasize preventative
metrics as the benefits scopeshrink elsewhere.
(07:33):
So as we're seeing shrinkagein the non medical services, we're
seeing good expansion herewith good old preventative metrics.
And seven because I like thenumber seven sometimes although I
like eight better is riskadjustment is fully transitioning
now.
Fully transitioning.
(07:54):
So it's been in transition.
And when I read this from thecms, I remembered how it's been transitioning
for some time now, is nowusing the full 2024 CMS HCC risk
model, whatever that means.
Right.
I mean it's complicated.
They're updating algo, et cetera.
The point of this podcast istell you how that works, especially
if you're driving.
(08:14):
But what happens is that itbrings you $12.9 billion in savings
to particularly trust fundwhich as a millennial, I'm very much
for that trust fund being preserved.
Of course $12.9 billion is nota whole lot, right?
But the Medicare Advantageorganizations could use some mitigation
(08:37):
in terms of how much riskadjustment they get retro and moving
forward.
So again, while the details ofthis I do not know if you are into
providing the HCC riskmodeling for plants, this is something
you should Be reading, sendme, tell me your notes.
All right, so I'm going tofocus on three.
Why don't I focus on threeareas that I just talked about and
(09:01):
delve a little bit deeper andbring you some food for thought.
Okay, so what did I say at thebeginning of this podcast?
I said what CMS just changedfor 2026.
I talked about 5% boost inMedicare Advantage payments for 2026.
That is a $25 billion flowinto health plans.
(09:26):
This is higher than theoriginal proposal.
I know some of you might haveheard, you know, earlier this year,
MA plans are getting a boost, etc.
Now we know it's a 5% boostand stocks for these insurance companies
jumped overnight when this was announced.
So let's be clear that moneydoesn't automatically make it to
(09:46):
providers or innovators.
Okay, you're not getting a $25billion check at least yet.
It's a margin opportunity andhow it's deployed will decide who
thrives.
But first you decide if youthrive and then how you deploy this
margin opportunity will be thedecisive factor in your performance
(10:09):
in 2026.
Remember, at the same time,CMS is tightening the belt on supplemental
benefits perks like meals,over the counter, transportation,
all of these are being scaled back.
So what I want you to thinkabout also is that if you had a strategy,
if you're one of these stateswhere you said, let's say California,
(10:29):
where you do get paid for nonmedical services like meals under,
for instance, the Calaimprogram and so on, you would have
been smart to couple that withyour Medicare supplemental benefit
programs.
Now would you have, I mean,you know, conf figured how those
(10:51):
would be rolled backpotentially because they, they're
optional supplemental benefits.
OSP.
They're not MSPs, those aremandatory supplemental benefits.
So the message is simple.
Benefits should be connectedto outcomes, not just marketing fluff.
We don't want to see marketing fluff.
And I'm glad that CMS isactually putting in mechanisms to
(11:14):
reduce that.
And then I told you about therisk adjustment.
I want to talk about virtualcare here.
The most important changereally is that behavioral telehealth
is being made permanent.
No geographic restrictions.
This really cements behavioralhealth as one of the pillars of Medicare
Advantage strategy.
But that's not all.
That's not all.
Remember I told you about newbilling codes available I was sharing
(11:37):
with DJ earlier.
These new billing codes updatethe Diabetes Prevention program model,
which probably we should do anepisode on.
And they provide new codingfor remote monitoring.
So CMS isn't just dipping itstoe in the water.
If you need a translation.
Okay.
It's building the pipes fordigital health.
Building the delivery systemfor digital health.
You know that the presidentadministration is very forward on
(12:02):
digital is very forward onkind of looking outside the box.
Okay.
So if you're a provider group,a health plan startup, my question
is this.
Are you treating virtual carelike a bolt on or are you backing
it into the core of your care model?
Because in 2026 virtual isn'tan experiment, it's table stakes.
(12:26):
If you're virtual only youhave challenges.
If you're brick and mortaronly you have challenges.
What is your hybrid strategynow that's going to lead into.
I'm going to tell you whatpayers really want in 2026.
What are they looking for?
Efficient care delivery.
What does that mean?
(12:48):
Do the thing that you need todo to get the outcomes that is desired
and do it in a way that isteam based as virtual first, that
has boots on the ground.
Next is your compliance muscle.
The risk model shifts makestop making documentation and coding
audits more critical than ever.
(13:09):
Plans don't want partners whoare creative with coding.
Don't get creative.
There's get creative withother things.
They want partners who are bulletproof.
So please scale it down withthe excessive PowerPoint slides talking
about numbers that havenothing to do with that particular
client or prospect.
The MA plan.
(13:30):
What is your digital memberengagement strategy?
Seniors are switching plans athigher rates.
So if I'm Humana and mypatients, my seniors are leaving.
Well I'm going to like if Ihear a solution that keeps members
loyal, simplifying benefits,reducing surprise costs and using
digital channels to build trust.
(13:51):
Next is Star performance.
Every operational leader istied back to stars and with new measures
like breast cancer screeningbeing phased in.
Are you a forward looking provider?
Are you building processesthat now now to stay ahead?
Are you building processes tobe ahead?
Think about it.
Are you building process toaccommodate current chaos?
(14:16):
And last is scalability.
It's a word that's been thrownaround, it's lost its shine.
Scalability is for instancewhether it's forms, health risk assessments,
prior auth changes,contracting, network management,
etc.
Health plans want partners whocan adapt quickly without breaking
operations.
(14:37):
We're not looking to disrupt,we're looking to facilitate.
We're looking to enhance.
So this is where I stand youguys, this is where I land.
The 2026 showdown in MedicareAdvantage is about focus and execution.
Yes, there's more money flowing.
Yes, virtual care is becoming permanent.
But the winners won't be theones trying to do everything.
(15:00):
The winners will be these people.
One they're nailing risk adjustment.
They're getting what it meansby compliance.
They have world class star operations.
They use virtual health not asa perk, but as a backbone of care
delivery.
And they don't rely just on virtual.
Seniors don't care about CMSmemos or risk models.
Right.
They care about trust,clarity, outcomes, how they feel
(15:24):
when they interact with that system.
Are they further relaxed or dothey feel tension?
Do they feel cared for or dothey feel abandoned?
If you get that right, therevenue flows and it will flow.
I just told you the sum isabout to be flowing.
So here's your challenge in 2026.
Pick your battleground.
(15:44):
What will it be?
Will it be stars?
Virtual care?
Documentation, integrity?
Whatever it is, commit, investand execute at the world class level,
standardized with your payer partners.
Because this is not justanother year in Medicare Advantage.
It is a turning point.
(16:04):
And with that, I'm AlexArijanian and this has been the Value
Based Care Advisory podcast.
Thanks for tuning in and I'llsee you next time.
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