AMGA Calls for Medicare Advantage Reforms to Protect Patient Access

Alexandria, VA – AMGA today submitted comments to the Centers for Medicare & Medicaid Services (CMS) on proposed Medicare Advantage (MA) policy changes for Contract Year 2027, highlighting critical concerns about physician reimbursement, care coordination, and patient outcomes. AMGA’s intention with its recommendations is to strengthen the MA program so it supports the ability of medical groups and integrated systems of care to deliver high-quality, coordinated care to the more than one in three Americans served by AMGA's 177,000 member physicians.

“Getting these Medicare Advantage reforms right is essential to ensuring patients maintain access to coordinated, high-quality care from physicians equipped to manage their complex health needs,” said Jerry Penso, MD, MBA, president and chief executive officer of AMGA. “With proper risk adjustment, prompt reimbursements, and meaningful, actionable quality measures, Medicare Advantage can avoid the wasteful administrative burden that plagues traditional Medicare, burdens that diverts time and resources away from quality patient care and contributes to physician burnout.”

CMS in the proposed rule sought feedback on potential reforms to MA, including improving risk adjustment accuracy and fairness, reforming Star Ratings and quality bonus payments, and promoting well-being, preventive care, and nutrition to support long-term health outcomes.

In its comments, AMGA urged CMS to require Medicare Advantage Organizations to pass through acuity-adjusted capitated payments directly to providers delivering care to complex patients, ensuring financial accountability aligns with clinical responsibility. AMGA emphasized that adequate reimbursement is fundamental to maintaining the infrastructure, staffing, and care coordination services required for high-risk populations.

AMGA also recommended incorporating outcome-based measures into Star Ratings, including prior authorization timeliness, denial overturn rates, and prevention of functional decline. The organization also urged CMS to reduce the current two- to three-year lag between performance measurement and quality bonus payment determination.

“Delays in authorization and care transitions contribute directly to functional decline, increased caregiver burden, and avoidable utilization,” Penso said. “These are not merely administrative inconveniences but have real consequences for patients and families.”

The letter is available on the AMGA website.

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About AMGA
AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.

AMGA represents medical groups and integrated systems of care. Its diverse membership includes multispecialty medical groups, integrated delivery systems, accountable care organizations, and other entities committed to improving healthcare outcomes. AMGA advocates for the formation of innovative, clinically integrated systems of care that advance population health, enhance patient experience, and reduce healthcare costs. For more information, please visit www.amga.org.