Michael Ha

And for Medicare Advantage and everything, Medicaid as well, he wants to eliminate fraud, reduce waste.

And when you think about Medicare Advantage and how it relates to what just happened last night, this rate notice, the biggest surprise within this rate notice is what they're doing on risk model changes.

And I know this is going to be very technical and granular, but it's important to understand because what the government believes is that there's a lot of fraud

in risk coding, in risk adjustment.

There's been a lot of articles from Wall Street Journal, for example, about companies like UnitedHealth, OptumHealth, improperly risk coding because, and if you bear with me for 15 seconds, I'll explain why it matters.

So we mentioned how every Medicare Advantage plan gets paid a benchmark rate for every senior.

And let's call it

even number, $1,000 per member per month, so $12,000 annually.

But it's unfair if, for example, your member might have diabetes and cancer and AIDS.

You're incurring much more costs.

So as a health plan, you should be getting paid more to match the utilization, which is why the government created something called the risk score.

And basically it's a multiplier effect.

If you're healthy, you might be 1.0, 1.0 times 1,000.

But if you have a multitude of comorbidities, that might be 2.0, that might be 10.0 times 1,000.

And this risk score is justified by health insurers collecting codes to justify your health status.

And there are a lot of players in the game, a lot of health insurers who've been very aggressive

arbitraging that risk code payment mechanism because it's clearly so impactful to revenue, drops right to bottom line.

So to basically circle back, this rate notice, the most surprising impact is what it's done to risk adjustment in tightening it, making it

less difficult to be aggressive, if you will.

So you're seeing the most aggressive risk coders, like UnitedHealth, seeing the biggest impact today.