The growth of Medicare Advantage is an existential threat to skilled nursing facilities. Frequently defined by poor rates, punitive UM practices, and routine denials, the relationship between SNFs and MA Plans has reached a dysfunctional low. But it doesn’t have to be this way. Through a greater understanding of how MA plans work and what motivates their actions, providers can start to build healthier relations, craft better contracts and generate more negotiating leverage. We’re taking an up-close look at the Medicare Advantage business model to understand:

• How MA manages (or doesn’t manage) post acute spend
• Why it’s essential for providers to understand Medical Loss Ratio
• What performance metrics MA plans value most

Nurse Learner Outcome: Upon completion of this educational session, 80% of the nurses will be able to describe the Medicare Advantage (MA) business model, explain how MA plans manage post-acute care spending, interpret the significance of Medical Loss Ratio (MLR), and identify key performance metrics valued by MA plans to support improved collaboration and negotiation strategies with MA organizations.

Learner Objectives:

1. Describe the core components of the Medicare Advantage (MA) business model, including how MA plans manage post-acute care spending and the implications for skilled nursing facilities.
2. Explain the concept of Medical Loss Ratio (MLR) and its influence on MA plan decision-making, reimbursement practices, and provider engagement strategies.
3. Identify key performance metrics valued by MA plans and discuss how understanding these metrics can support improved negotiation, contracting, and collaboration between SNFs and MA organizations.