I hope that we see technology and analysis used to improve outcomes rather than to screen or filter the customer pool. I worry that this will happen without protections in place.
One of the nice benefits of being a Medicare Advantage provider is that there is a set comprehensive of member-oriented regulations and protections in place that force us to benefits the member. In this case, the government pays us on a risk-adjusted basis (based on CMS-set risk-adjustment factors.) We are therefore incentivized to comprehensively collect and document every member's risk, so that we are able to manage their medical expenses. (Also worth noting: we are required by law to spend 85% of our payments directly on member care.)
