How Alignment Health gets health systems to come to them | John Kao (Alignment Health)

Thirty-five years into Medicare Advantage, John Kao sees the V28 correction as a pricing reset, not a structural rupture. Plans that invested in clinical care delivery are emerging from it better positioned than those that leaned on coding and prior auth. He expects MA to capture 65–70% of the senior market within the next decade — and argues the current administration's push on program integrity is accelerating, not threatening, that trajectory.

The second half of the conversation turns to health systems. Hospitals that are over capacity are coming to Alignment Health not out of ideological alignment on value-based care, but because reducing senior admissions frees up beds for commercial patients who reimburse at higher rates. Alignment's pitch is that it can deliver on that operationally — 142 acute admissions per thousand versus original Medicare's roughly 250 — while also moving market share into the system. The business case, he argues, makes the ideological one unnecessary.

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Links referenced

Follow John on LinkedIn: https://www.linkedin.com/in/johnkao1/

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