Our industry does a good job complaining about managed care and Medicare Advantage (MA) issues relating to payment, denials and administrative burden. But are we telling the story  in an effective way for advocacy purposes? To be effective, we need to shift the focus from process frustration to patient impact. 

 

When we meet with legislators on reimbursement, we’re successful because we center the conversation on people. We approach it in a way that tells the patient and worker's story. That insufficient reimbursement leads to difficulty attracting enough workers, resulting in patients going without care they're authorized for. 

 

Yet with Medicare Advantage, our message often gets diluted by complaints about reimbursement levels or marketing tactics. What truly moves policymakers are the real-world consequences for patients. But on Medicare Advantage, we often gripe about reimbursement, the increase in enrollment as a result of suspicious marketing tactics and patients not getting what they were sold. 

 

So, I challenge all of you to share real examples of patients you’ve cared for — or attempted to care for — who were denied services or saw reductions because of managed care decisions. These examples let us show lawmakers what’s happening beyond the data and why reform can’t wait.