\u7f8e\u570b\u4e3b\u8981\u5065\u5eb7\u4fdd\u96aa\u516c\u53f8\u80a1\u50f9\u5728\u76e4\u5f8c\u4e0b\u8dcc\uff0c\u539f\u56e0\u662f\u83ef\u5e9c\u64ec\u5b9a\u5728 2027 \u5e74\u57fa\u672c\u4e0a\u5c07 Medicare Advantage \u57fa\u672c\u7d66\u4ed8\u4fdd\u6301\u5e7e\u4e4e\u4e0d\u8b8a\uff0c\u4e26\u8457\u624b\u525d\u96e2\u4e00\u9805\u95dc\u9375\u7684\u98a8\u96aa\u8abf\u6574\u6536\u5165\u4f86\u6e90\u3002\u4f86\u81ea Centers for Medicare and Medicaid Services \u7684\u8349\u6848\u5efa\u8b70\u589e\u52a0 0.09%\uff0c\u800c\u83ef\u723e\u8857\u9810\u671f\u70ba 4% \u81f3 6%\u3002Humana \u5728\u76e4\u5f8c\u4ea4\u6613\u4e2d\u4e00\u5ea6\u4e0b\u8dcc\u9054 13%\uff0cUnitedHealth\u3001CVS\u3001Elevance\u3001Cigna \u8207 Centene \u4e5f\u540c\u6a23\u8df3\u6c34\u3002<\/p>\n
\u9019\u9805\u63d0\u6848\u89f8\u53ca\u7ba1\u7406\u5f0f\u91ab\u7642\u6295\u8cc7\u6848\u4f8b\u7684\u6838\u5fc3\u3002\u79c1\u4eba\u8a08\u756b\u9577\u671f\u4ef0\u8cf4\u7a69\u5b9a\u7684\u4e2d\u500b\u4f4d\u6578\u5e74\u5ea6\u8cbb\u7387\u4e0a\u8abf\u4f86\u63a8\u52d5\u6210\u9577\uff0c\u540c\u6642\u8cc7\u52a9\u66f4\u512a\u539a\u7684\u7d66\u4ed8\u4e26\u5438\u6536\u4e0a\u5347\u7684\u91ab\u7642\u6210\u672c\u3002\u63a5\u8fd1\u96f6\u7684\u8abf\u6574\u91cd\u7f6e\u4e86\u9019\u5957\u8a08\u7b97\u3002\u6295\u8cc7\u4eba\u5df2\u7d93\u5c0d\u53bb\u5e74\u5229\u7528\u7387\u56de\u5347\u5f8c\u653f\u7b56\u8da8\u7dca\u6709\u6240\u6e96\u5099\uff0c\u4f46\u6c92\u60f3\u5230\u6703\u7dca\u5230\u9019\u7a2e\u7a0b\u5ea6\uff1a\u5e02\u5834\u671f\u5f85\u5927\u591a\u96c6\u4e2d\u5728 4% \u81f3 6%\uff0c\u4ee5\u6db5\u84cb\u8da8\u52e2\u3001\u7de8\u78bc\u8207\u661f\u7b49\u8a55\u6bd4\u8b8a\u52d5\u3002\u76f8\u53cd\u5730\uff0cCMS \u958b\u51fa\u63a5\u8fd1\u51cd\u7d50\u7684\u521d\u76e4\uff0c\u4e26\u518d\u52a0\u4e0a\u6703\u4f7f\u6de8\u5f71\u97ff\u66f4\u56b4\u91cd\u7684\u653f\u7b56\u3002\u8a72\u7522\u696d\u7684\u62cb\u552e\u4e0d\u50c5\u50c5\u662f\u6a19\u984c\u9020\u6210\u7684\u6050\u614c\uff0c\u800c\u662f\u5c0d\u73fe\u91d1\u6d41\u8ecc\u8de1\u7684\u57fa\u672c\u91cd\u65b0\u5b9a\u50f9\uff0c\u5c24\u5176\u662f\u5c0d\u90a3\u4e9b\u9ad8\u5ea6\u66dd\u9732\u65bc Medicare Advantage \u7684\u627f\u4fdd\u8005\u3002Humana \u7684\u96c6\u4e2d\u5ea6\u4f7f\u5176\u53d7\u5275\u6700\u6df1\uff1bUnitedHealth \u85c9\u7531 Optum \u7684\u591a\u89d2\u5316\u63d0\u4f9b\u90e8\u5206\u7de9\u885d\uff0c\u4f46\u4e26\u975e\u514d\u75ab\u3002CVS \u8207 Elevance \u5206\u5225\u900f\u904e Aetna \u8207 Anthem \u54c1\u724c\u8a08\u756b\u9762\u81e8\u96d9\u91cd\u885d\u64ca\u3002<\/p>\n
\u9664\u4e86\u540d\u7fa9\u4e0a\u7684\u8cbb\u7387\u5916\uff0cCMS \u9084\u64ec\u5c07\u8207\u975e\u7279\u5b9a\u5c31\u91ab\u8a18\u9304\u7684\u4fdd\u96aa\u516c\u53f8\u75c5\u6b77\u5716\u8868\u5be9\u67e5\uff08medical chart reviews\uff09\u4f86\u6e90\u8a3a\u65b7\u6240\u9023\u52d5\u7684\u652f\u4ed8\u4e88\u4ee5\u53d6\u6d88\u3002\u8a72\u6a5f\u69cb\u4f30\u8a08\uff0c\u50c5\u6b64\u4e00\u9805\u5c31\u6703\u4f7f 2027 \u5e74\u652f\u4ed8\u7387\u964d\u4f4e 1.53 \u500b\u767e\u5206\u9ede\u3002\u6b64\u8b8a\u66f4\u91dd\u5c0d\u9577\u671f\u5b58\u5728\u7684\u300c\u5347\u7d1a\u7de8\u78bc\uff08upcoding\uff09\u300d\u722d\u8b70\uff0c\u76e3\u7ba1\u55ae\u4f4d\u6307\u63a7\u8a08\u756b\u5229\u7528\u5716\u8868\u5be9\u67e5\u8207\u5065\u5eb7\u98a8\u96aa\u8a55\u4f30\uff08HRA\uff09\u4f86\u63d0\u9ad8\u98a8\u96aa\u5206\u6578\u8207\u652f\u4ed8\uff0c\u537b\u6c92\u6709\u76f8\u61c9\u7684\u81e8\u5e8a\u5c31\u91ab\u73fe\u5834\u3002\u5982\u679c\u8349\u6848\u7167\u63d0\u8b70\u5b9a\u6848\uff0c\u5c07\u964d\u4f4e\u98a8\u96aa\u5206\u6578\u3001\u6e1b\u5c11\u6bcf\u4f4d\u6703\u54e1\u7684\u8a08\u756b\u6536\u5165\u4e26\u58d3\u7e2e\u5229\u6f64\u7387\u2014\u2014\u7279\u5225\u662f\u90a3\u4e9b\u9ad8\u5ea6\u501a\u8cf4\u5716\u8868\u5be9\u67e5\u8a08\u756b\u7684\u627f\u4fdd\u8005\u3002\u653f\u7b56\u5236\u5b9a\u8005\u50b3\u905e\u7684\u8a0a\u606f\u5f88\u660e\u78ba\uff1a\u91cd\u8996\u652f\u4ed8\u6e96\u78ba\u6027\u52dd\u65bc\u71df\u6536\u512a\u5316\u3002\u8fd1\u5e74\u4f86\u76e3\u7ba1\u6a5f\u69cb\u5df2\u6536\u7dca\u98a8\u96aa\u8abf\u6574\u898f\u5247\u4e26\u52a0\u5f37\u7a3d\u6838\uff1b\u6b64\u63d0\u6848\u66f4\u9032\u4e00\u6b65\uff0c\u5207\u65b7\u4e86\u4e00\u500b\u5c0d\u8a72\u5546\u696d\u6a21\u5f0f\u81f3\u95dc\u91cd\u8981\u7684\u6536\u5165\u69d3\u687f\u3002<\/p>\n
\u5728\u8cbb\u7387\u9b06\u52d5\u7a7a\u9593\u6d88\u5931\u7684\u60c5\u6cc1\u4e0b\uff0c\u8a08\u756b\u5fc5\u9808\u8fc5\u901f\u5c31 2027 \u5e74\u51fa\u50f9\u63a1\u53d6\u884c\u52d5\u3002\u53ef\u52d5\u7528\u7684\u69d3\u687f\u96d6\u719f\u6089\u4f46\u75db\u82e6\uff1a\u63d0\u9ad8\u4fdd\u8cbb\u3001\u524a\u6e1b\u88dc\u5145\u6027\u7d66\u4ed8\u3001\u6536\u7dca\u91ab\u7642\u7db2\u7d61\u3001\u964d\u4f4e\u7d93\u7d00\u4f63\u91d1\uff0c\u6216\u8ffd\u6c42\u53ef\u80fd\u9700\u6642\u624d\u80fd\u5be6\u73fe\u7684\u91ab\u7642\u6210\u672c\u7bc0\u7701\u3002\u82e5\u7121\u5c0d\u6c96\uff0c\u91ab\u7642\u640d\u5931\u7387\uff08Medical Loss Ratio\uff09\u5c07\u4e0a\u5347\u3002\u6578\u5bb6\u627f\u4fdd\u8005\u5df2\u5728\u61c9\u5c0d\u9580\u8a3a\u5229\u7528\u7387\u4e0a\u5347\u8207\u85e5\u5c40\u901a\u8ca8\u81a8\u8139\uff1b\u518d\u758a\u4e0a\u6536\u5165\u9006\u98a8\u5c07\u5a01\u8105\u76c8\u9918\u4f30\u503c\u3002\u5c0d\u6d88\u8cbb\u8005\u7684\u9023\u9396\u6548\u61c9\u53ef\u80fd\u662f\u984d\u5916\u798f\u5229\u8b8a\u5c11\u2014\u2014\u7259\u79d1\u3001\u8996\u529b\u8207\u5065\u8eab\u7b49\u798f\u5229\u6e1b\u5c11\uff0c\u4ee5\u53ca\u8a08\u756b\u5728\u91cd\u65b0\u5b9a\u50f9\u7522\u54c1\u8a2d\u8a08\u6642\u91ab\u7642\u63d0\u4f9b\u8005\u7684\u53ef\u53ca\u6027\u8b8a\u7a84\u3002\u524a\u6e1b\u7d66\u4ed8\u98a8\u96aa\u5305\u62ec\u661f\u7b49\u8a55\u6bd4\u4e0b\u964d\u8207\u6703\u54e1\u6d41\u5931\uff0c\u4f46\u627f\u64d4\u6210\u672c\u58d3\u529b\u5247\u98a8\u96aa\u662f\u5229\u6f64\u60e1\u5316\u3002\u6295\u8cc7\u4eba\u6b63\u5728\u70ba Medicare Advantage \u8f03\u4f4e\u7684\u5229\u6f64\u4e0b\u6ed1\u8def\u5f91\u4ee5\u53ca\u8207\u8a72\u696d\u52d9\u76f8\u95dc\u7684\u8f03\u6162\u76c8\u9918\u6210\u9577\u8ecc\u8de1\u91cd\u65b0\u6821\u6e96\u9810\u671f\u3002<\/p>\n
\u6b64\u63d0\u6848\u5e36\u6709\u660e\u986f\u7684\u653f\u6cbb\u8a0a\u865f\u3002\u653f\u5e9c\u6b63\u512a\u5148\u8003\u91cf\u7d0d\u7a05\u4eba\u7bc0\u7701\u8207 Medicare Advantage \u7684\u65b9\u6848\u5b8c\u6574\u6027\uff0c\u800c\u8a72\u8a08\u756b\u73fe\u5df2\u6db5\u84cb\u8d85\u904e\u4e00\u534a\u7684\u5408\u683c\u9577\u8005\u3002\u5c0d\u8cbb\u7387\u8207\u7de8\u78bc\u63a1\u53d6\u8f03\u5f37\u786c\u7acb\u5834\u7b26\u5408\u9019\u6a23\u7684\u6558\u4e8b\u3002\u5e02\u5834\u5c0d\u65bc\u300c\u6700\u7d42\u898f\u5247\u5c07\u5e36\u4f86\u5927\u5e45\u5229\u591a\u300d\u7684\u671f\u5f85\u73fe\u5728\u986f\u5f97\u6a02\u89c0\u3002\u63a5\u4e0b\u4f86\u6703\u6709\u610f\u898b\u5fb5\u6c42\u671f\uff0c\u6b77\u53f2\u4e0a CMS \u6703\u5728\u7522\u696d\u53cd\u5f48\u4e0b\u8abf\u6574\u7d44\u6210\u8981\u7d20\u2014\u2014\u6b63\u898f\u5316\u4fc2\u6578\u3001\u8da8\u52e2\u5047\u8a2d\u3001\u661f\u7b49\u8b8a\u52d5\u7b49\u3002\u6700\u7d42\u516c\u544a\u9810\u5b9a\u5728\u56db\u6708\u767c\u5e03\uff0c\u8a08\u756b\u51fa\u50f9\u5c07\u5728\u516d\u6708\u9032\u884c\u3002\u627f\u4fdd\u8005\u3001\u7522\u696d\u5718\u9ad4\u8207\u91ab\u7642\u63d0\u4f9b\u8005\u5c07\u4e3b\u5f35\uff0c\u5e73\u5766\u7684\u8cbb\u7387\u8207\u7de8\u78bc\u9650\u5236\u7d50\u5408\u5c07\u8feb\u4f7f\u6e1b\u5c11\u9577\u8005\u7684\u7d66\u4ed8\u3002CMS \u662f\u5426\u6703\u5c0d\u5716\u8868\u5be9\u67e5\u7684\u53d6\u6d88\u63d0\u4f9b\u5206\u968e\u6bb5\u5be6\u65bd\uff0c\u6216\u8abf\u6574\u98a8\u96aa\u5206\u6578\u7684\u6b63\u898f\u5316\uff0c\u5c07\u6c7a\u5b9a\u6de8\u5f71\u97ff\u662f\u4ecd\u7136\u6df1\u5ea6\u8ca0\u9762\u9084\u53ea\u662f\u66f4\u70ba\u7dca\u7e2e\u3002\u5206\u6790\u5e2b\u5df2\u8b66\u544a\u6b64\u904e\u7a0b\u770b\u8d77\u4f86\u66f4\u53d7\u653f\u6cbb\u5f71\u97ff\uff0c\u5373\u4fbf\u6700\u7d42\u6578\u5b57\u6709\u8edf\u5316\uff0c\u80a1\u50f9\u56de\u5347\u4e5f\u53ef\u80fd\u9700\u8981\u6642\u9593\u3002<\/p>\n
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