On May 15,, our CEO Mike Desjadon joined Kelly Evans on CNBC’s The Exchange to discuss the future of Medicare Advantage (MA) and why fixing how care gets approved and paid for is critical — not just for patients, but for the sustainability of the entire healthcare system.
The interview centered on the rising scrutiny of Medicare Advantage, a program that now covers more than half of all Medicare beneficiaries. What was once promoted as a cost-saving solution — giving private insurers federal dollars to manage care more efficiently — has in many ways failed to live up to that promise.
“The idea was that we’d create the right incentives to reduce the cost of care,” Mike said. “But when you start peeling back the onion, you realize how complex and misaligned those incentives can be.”
One of the most controversial practices, upcoding, illustrates this perfectly. Insurers receive more reimbursement if a patient appears sicker — but that can lead to documentation of conditions that aren’t actively being treated. For example, a home health nurse administering a treatment like Humira might note a patient also has glaucoma, even if it's unrelated to the care being delivered during that visit. That data makes the patient seem sicker, increasing payments to the insurer, without necessarily increasing the care the patient receives.
This disconnect — between how sick a patient appears on paper and the care they actually get — is one of the reasons MA is estimated to cost $50 billion more annually than traditional Medicare, according to the Medicare Payment Advisory Commission (MedPAC).
At the same time, patients and providers are also dealing with care denials and delays, even as insurers collect higher payments. As Kelly Evans noted, “when you're kind of both upcoding and maybe making it super challenging to get these treatments signed off on… that’s where it really starts to raise questions.”
Mike emphasized that while Medicare Advantage is here to stay — and will likely continue to grow — real reform is coming. “The administration has been very clear that the administrative bloat and cost running through healthcare is squarely in their crosshairs,” he said. That means insurers will need to find ways to operate more efficiently — by paying faster, denying less, and improving transparency.
That’s exactly where technology companies like Anomaly come in. Our platform helps eliminate friction between payers and providers by improving how care is documented, authorized, and reimbursed. The result: less waste, fewer denials, and faster payments — all while staying compliant with evolving regulations.
The Medicare Advantage conversation is far from over. But one thing is clear — if this program is going to deliver on its original promise, it must evolve. We’re proud to be part of that transformation.
