Becker’s Payer Issues Roundtable 2025: Charting Medicare Advantage growth

In April, the Becker’s Payer Issues Roundtable 2025 gathered industry leaders to examine the key challenges facing payers, including the impact of changing regulations and the future of Medicare Advantage (MA). Marcos Dachary, Principal and Chief Market Strategist and General Manager of Payer Solutions at Milliman MedInsight, participated in a panel discussion to explore topics such as MA market growth, value-based care models, and the impact of predictive analytics and artificial intelligence (AI) on MA. We had the opportunity to sit down with Marcos to gain deeper insights into his perspective on navigating Medicare Advantage.

Market Growth and Competition

1. As MA continues to grow, what new strategies will be important for capturing more of this market in the coming years?

The MA market is indeed growing, but it’s also becoming more competitive and cost pressured. Currently, two large plans that hold nearly half of the market are grappling with higher-than-expected care costs that have impacted their profit outlooks. This shift opens the door for smaller regional plans to expand their presence and offer more localized, tailored coverage. To capture growth opportunities, it’s crucial to deploy data-driven strategies, like using advanced analytics for personalized plan design, forging value-based partnerships with providers, and leveraging predictive modeling to manage risk. Taken together, these approaches enable plans to fine-tune their offerings, more accurately control costs, and better align with CMS guidelines—all of which will help them stay competitive in an increasingly crowded market.

2. How can health plans use predictive analytics and AI to boost member retention, improve risk adjustment, and coordinate care in Medicare Advantage?

When it comes to leveraging predictive analytics and AI in the Medicare Advantage space, I believe there are three standout areas that health plans should focus on. First, these tools can dramatically improve member retention when you can group members into more accurate cohorts based on their health status and utilization patterns. With this level of granularity, plans can deliver the right care and support at just the right time, which enhances member satisfaction and loyalty.

Second, ensuring risk adjustment accuracy is essential. Automated algorithms not only help plans identify under-coded diagnoses more quickly, but they also provide a more precise picture of each member’s health. That translates to accurate payments, reduced compliance concerns, and fairer compensation for providers.

Finally, predictive analytics and AI can really enhance care coordination. When a plan can spot members at high risk of gaps in care or poor engagement, it can adjust workflows in near real time, automate tasks, and refine care pathways to improve outcomes and reduce avoidable hospitalizations. Taken together, these strategies lead to stronger performance in the MA market and, ultimately, better care for members.

3. How can MA plans best engage providers and align incentives to improve outcomes and reduce costs as they move toward value-based care models?

From my experience, one of the most effective ways to engage providers and align incentives in a value-based care model is to start by building trust and transparency. Specifically, ensuring interoperability through EMR/EHR data integration allows MA plans to share near real-time clinical insights, which reduces redundant tasks and promotes shared accountability for accurate risk capture.

It’s also helpful for plans to use reputable third-party benchmarks, such as those from Milliman, to demonstrate an objective performance standard. This kind of external validation helps providers see exactly where they stand relative to industry norms, encouraging them to adopt best practices and improve risk adjustment outcomes.

Another critical component is leveraging contemporary workflow tools and AI-driven technologies, like those offered in the Milliman® MedInsight Risk Adjustment Platform. Solutions like automated coding suggestions, predictive modeling, and real-time alerts can seamlessly fit into existing systems, reducing manual effort and enhancing accuracy.

Finally, it’s essential to minimize provider abrasion by distributing responsibility. Offering EHR integration and scaling outreach campaigns goes a long way toward reducing administrative burden. This makes it clear that thorough documentation and accurate coding benefit not only patient care but also fair reimbursement—ultimately ensuring that everyone’s incentives are properly aligned.

One aspect of the Risk Adjustment Platform I’m highly enthusiastic about is the synergy between MedInsight’s data enrichment platform and robust workflows. By merging these strengths, we’re able to gather and transform raw data into strategic insights quickly and accurately—insights that can drive critical decision-making around cost, compliance, and patient outcomes. Ultimately, it’s this blend of advanced analytics with practical, real-time clinical applications that distinguishes us in the market. The result is a holistic, all-encompassing solution that empowers healthcare organizations with the clarity, agility, and confidence they need to excel in a constantly evolving environment.

4. What additional resources are available to prepare for MA growth?

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