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As the healthcare industry continues to evolve, Medicare Advantage plans have become increasingly challenging for health systems. This is due to a rise in denied and delayed coverage, which has led to a decline in hospital cash reserves. Despite this, Medicare Advantage enrollment is on the rise, with insurers seeing an opportunity as more people become eligible for the program. However, some health systems are struggling to work with Medicare Advantage plans that deny care to boost their earnings.

One such system is UNC Health, which has developed partnerships with more reliable payers and is considering contracting with fewer Medicare Advantage plans that are not good partners. According to Will Bryant, CFO of UNC Health, health systems need better communication and partnerships with payers to develop mutually beneficial solutions without interference from regulatory bodies like CMS. He hopes that future payer-provider partnerships will help solve the problems that have arisen over the last 30-plus years.

In response to these challenges, CMS has proposed new regulations aimed at improving communication between health systems and Medicare Advantage plans. These include prohibiting volume-based bonuses to third-party marketing organizations and requiring health plans to provide a mid-year notice for any supplemental benefits changes enacted. The hope is that these regulations will lead to better partnerships and communication between health systems and Medicare Advantage plans, ultimately improving patient care and outcomes.

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