Philo D. Hall, Member of the Firm in the firm’s Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Modern Healthcare, in “Puerto Rico: The ‘Canary in the Coal Mine’ for Medicare Advantage Growth,” by Maya Goldman. (Read the full version – subscription required.)
Following is an excerpt:
Medicare Advantage enrollment expands each year, with 2.3 million new people covered in 2022. As the program grows, however, its payment system could need a significant reboot.
Puerto Rico, which has the highest proportion of Medicare Advantage enrollees among all states and territories, offers a glimpse of what insurers in other jurisdictions may face. The territory’s low rates of traditional fee-for-service Medicare enrollment—on which Medicare Advantage payments are based—present challenges for insurance companies trying to run effective programs there. …
Puerto Rico’s high Medicare Advantage penetration and specific difficulties have unique causes, but the considerations for stateside insurance companies and policymakers are the same, said Philo Hall, a lawyer at law firm Epstein Becker Green. ...
“When you have an ever-diminishing, small fee-for-service population that is being used to set the rates for 60, 70, 80, 90% of the Medicare population under MA, any anomalies in that small population are going to be disproportionately distortive,” Hall said.
