EP463: Medicare Advantage Policies—Which Will Stay and Which Will Go Now? With Betsy Seals
Episode Description
In this episode, host Stacey Richter engages with Betsy Seals, CEO and co-founder of Rebellis Group, to analyze the future of key Medicare Advantage policies amidst a changing political landscape. They delve into four critical areas: the Medicare Advantage Stars Program and potential changes due to recent lawsuits and the new administration's stance on quality measures; risk adjustment and government oversight, including the focus on recouping improper payments; the use of artificial intelligence and what appropriate oversight for AI in prior authorization should look like; and agent and broker oversight, including increased scrutiny over marketing practices. Betsy emphasizes the importance for Medicare Advantage plans to prioritize patient value, maintain compliance, and proactively utilize data to navigate these evolving policies.
WHAT YOU'LL LEARN
✅ Whether the Star Ratings program will survive in its current form under the new administration, and how ongoing lawsuits against CMS policies could reshape it
✅ Why it's becoming harder for Medicare Advantage plans to survive, let alone thrive, under the current combination of political and regulatory pressure
✅ How AI is directly impacting beneficiary lives already — particularly in prior authorization — and what oversight should look like to keep that impact net positive
✅ What's currently happening with override payments, and why this is one of the more consequential but least understood levers in Medicare Advantage policy right now
✅ Why it's increasingly important for compliance teams to become more technologically savvy, given how much of the current oversight burden runs through data and AI systems
WHY THIS MATTERS
Medicare Advantage plans are navigating four simultaneous pressure points — Star Ratings uncertainty, risk adjustment oversight, AI governance, and agent/broker scrutiny — against the backdrop of a genuinely uncertain political environment. Betsy's core message is that plans who prioritize patient value and lean into compliance and data now will be far better positioned than those waiting to see how the policy landscape settles.
=== LINKS ===
🔗 Show Notes with all mentioned links: Episode Page
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00:00 Introduction
05:09 Will the Star Ratings program stay in this new administration?
08:08 How will the lawsuits against CMS policies play out with this new administration?
10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive?
16:22 How does AI directly impact beneficiary lives?
21:38 What's going on now with the override payments?
27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward?
31:45 Why is it important to become more technologically savvy in compliance?
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