The Centers for Medicare & Medicaid Services just proposed a $21 billion increase for Medicare Advantage plans. As a cancer survivor and healthcare innovator, I see a troubling irony: While insurers receive unprecedented funding, their growing market power is creating barriers to the very innovations that could transform patient care and reduce costs.

This matters because our healthcare system is at a breaking point. Hospital readmissions alone cost $62 billion annually, but the human cost is even greater. Every readmission represents a failure of our system — a patient suffering needlessly, a family’s life disrupted, and a preventable strain on our healthcare resources.

As Medicare Advantage enrollment surges past 30 million beneficiaries, we’re witnessing an unprecedented consolidation of healthcare power. MA plans are rapidly acquiring physician practices while simultaneously creating barriers that keep proven cost-saving technologies from reaching patients who need them most. This concentration of market power wasn’t supposed to happen. Medicare Advantage was designed to provide better care at lower costs through private-sector innovation. Instead, it’s building walls around innovation while reaping record profits.

My perspective on this crisis is both personal and professional. As a two-time cancer survivor, I’ve experienced firsthand how broken handoffs between providers and lack of continuous support can derail recovery. As CEO of Dimer Health, I lead a company committed to reducing hospital readmissions and improving care transitions using innovative technologies. Yet, I’ve seen how the current Medicare Advantage system actively discourages the adoption of solutions like ours — technologies that could prevent costly complications, enhance recovery, and improve patient outcomes.

The problem isn’t just about money, it’s about incentives. Current MA payment models reward plans for documenting patient illness rather than preventing it. This creates a perverse system where keeping patients sick but well-documented is more profitable than keeping them healthy. While CMS proposes a 4.33% rate increase for 2025, there’s no requirement that these billions be invested in patient care innovation.

The consequences are severe. Independent physicians face their fifth consecutive year of Medicare cuts, forcing many to limit Medicare patients or close entirely. Meanwhile, innovative care solutions face lengthy delays in MA network adoption, effectively blocking access to technologies that could reduce costs and improve outcomes.

But there are solutions:

  1. Tie MA payment increases to specific innovation and outcome metrics. Plans receiving billions in additional funding should demonstrate how that money improves patient care through the adoption of proven cost-saving technologies and support for independent practices.
  2. Require transparency in technology adoption and provider network decisions. When MA plans block innovative solutions that could reduce costs and improve care, they should explain why.
  3. Address the growing consolidation in healthcare delivery. When MA plans their own physician practices, they gain unprecedented control over patient care decisions. We need guardrails to ensure these decisions prioritize patient outcomes over corporate profits.

The stakes are too high to maintain the status quo. Every day, we delay reform, more independent practices close, more innovations like those at Dimer Health remain inaccessible, and more patients suffer preventable complications. The $21 billion Medicare Advantage windfall should be an opportunity to transform healthcare delivery, not entrench existing barriers to innovation.

We can create a healthcare system that truly puts patients first, but it requires rethinking how we allocate resources and align incentives. The solution isn’t less innovation, it’s ensuring that Medicare Advantage fulfills its original promise of better care at lower costs through meaningful competition and innovation.

The upcoming payment increase offers a critical moment for change. Will we use these billions to reinforce barriers to innovation, or will we seize this opportunity to build a healthcare system that works for everyone? The choice is ours, but patients can’t afford to wait.