The Vendorification of Medicare Advantage

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Publication Details

Journal
Health Affairs Scholar
Published
2026-09-04
DOI
https://doi.org/10.1093/haschl/qxag243
Primary Topic
Healthcare Policy and Management
Type
article
Field-Weighted Citation Impact
0.00
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article

The Vendorification of Medicare Advantage

David J. Meyers, Jeffrey Marr
Health Affairs Scholar
Healthcare Policy and Management
article

The Vendorification of Medicare Advantage

David J. Meyers, Jeffrey Marr
article en

Abstract

Abstract Medicare Advantage (MA) plans increasingly outsource core functions to third-party vendors, a trend termed the "vendorification" of MA. Vendors now play major roles in star-rating maximization, risk-code capture, and prior authorization, with evidence that vendor-conducted prior authorization yields higher denial rates and more appeal reversals than reviews conducted internally by insurers. This commentary examines three potential challenges that may be posed by vendorification: increased federal spending through non-budget-neutral risk adjustment and quality bonuses, opportunities to game medical loss ratio requirements, and weakened accountability to beneficiaries’ long-term health. Potential policy responses include mandatory reporting of vendor spending and, more fundamentally, reforming the payment incentives that make revenue-generating vendor services profitable.

Health Affairs Scholar
Brown University (US)
Partnerships for the goals
Openalex Percentile: Top 5%
Healthcare Policy and Management
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The Vendorification of Medicare Advantage — David J. Meyers, Jeffrey Marr · Health Affairs Scholar (2026) | TGRS Research Map | TGRS