Strengthening Medicare Advantage Through a Nurse’s Lens
By Jenni Gudapati, PhD, MBA, RN, Founder, HealthyInsights.AI and member of the federal Healthcare Advisory Committee
I have spent decades working in value-based healthcare, focused on improving outcomes. But the nurse in me also thinks about another outcome: whether the people we care for have what they need to stay healthy.
A treatment plan has to work in someone’s daily life. Can they afford their medications? Can they get to an appointment? Are they at risk for a fall? Are changes in cognition, function or social circumstances making it harder to manage their health? And do they have the support and understanding they need to manage a chronic condition? Those questions are central to whether care succeeds.
Following my 2026 appointment to the federal Healthcare Advisory Committee advising HHS and CMS, I have thought even more about the system we should be building — one that understands the whole person, identifies needs earlier, prioritizes wellness and prevention, and rewards quality, coordination and meaningful outcomes. That perspective also shapes my work leading value-based healthcare education at Boise State University and as founder of HealthyInsights.AI, where we focus on turning information about patients’ clinical, cognitive, functional and social needs into actionable insights for patients and their care teams.
That is why I support Better Medicare Alliance’s new Medicare Advantage Policy Roadmap. Its 10-point agenda offers Congress and CMS concrete approaches to strengthening Medicare Advantage while protecting affordability, choice and stability for beneficiaries. Several recommendations speak directly to what I have learned as a nurse and through my work in value-based care.
Connecting assessment to care
The roadmap’s recommendations around health risk assessments particularly resonate with me. With a background in home health, I know the tremendous value of meeting people where they are. But today, technology also gives us the opportunity to understand beneficiary needs in multiple settings, such as through an in-home visit, remotely from a beneficiary’s own home, or through pre-visit screening that gives the care team meaningful information before the patient ever enters the exam room.
The setting is less important than what we learn and what happens with that information.
Medication concerns, fall risk, cognitive changes, difficulty accessing food, caregiver strain or challenges managing daily activities can easily remain invisible during a traditional clinical encounter. Identifying these risks earlier gives care teams an opportunity to intervene before they become a crisis.
But assessment alone is not enough.
A medication concern should reach the clinician managing that patient’s care. An identified fall risk should prompt appropriate follow-up. Cognitive or functional changes should inform the care plan. An unmet social need should lead to an appropriate resource or support.
BMA’s roadmap calls for stronger clinical standards, follow-up care and information sharing with primary care providers following health risk assessments. That reflects a principle that is fundamental to value-based care: identifying risk creates value when the information reaches the right people and leads to meaningful action.
When assessments become part of a connected care continuum rather than an isolated event, they can support prevention, care coordination and earlier intervention, which are the very outcomes value-based care is intended to achieve.
Making coverage easier to use
The same attention to a beneficiary’s experience should guide prior authorization reform. Prior authorization serves an important purpose, but the process should be timely, transparent, and understandable for patients and their care teams.
BMA proposes shortening expedited decision timelines from 72 hours to 24 hours and requiring review by a licensed clinician before an AI-driven denial. For someone awaiting urgently needed care, a faster decision can reduce uncertainty and help care move forward. Clinical review also helps ensure technology supports — not replaces — appropriate clinical judgment.
These are practical changes with a clear purpose: helping beneficiaries receive appropriate care when they need it.
Protecting the stability people rely on
People managing chronic and complex conditions build routines around their coverage, clinicians, and benefits. Predictable policy helps support that continuity.
The roadmap’s emphasis on carefully testing next-generation risk adjustment and using a more predictable, multiyear update cycle deserves attention for that reason. Risk adjustment is essential to ensuring plans and providers have the resources necessary to care for beneficiaries with different levels of need. As we modernize these models, we should also continue improving our ability to understand the full picture of beneficiary health, including clinical, functional, and social factors that influence outcomes and costs.
This is one of the reasons I remain such a strong supporter of Medicare Advantage and value-based care. At their best, these models create the opportunity to move healthcare upstream, and from reacting to illness toward identifying risk earlier, coordinating care, and rewarding better outcomes.
For beneficiaries, that means something very practical: an identified need followed by help, a care team equipped with better information, a timely decision when care is needed, and coverage they can afford and rely on.
Congress and CMS have an opportunity to advance reforms that strengthen accountability while preserving and building upon what works in Medicare Advantage. BMA’s roadmap provides a substantive starting point.
Across my roles as a nurse, educator, healthcare innovator and federal advisory committee member, that is the lens I bring to these discussions: Did we identify what the person needs? Did we get that information to the people who can help? And did it result in better care?
For me, that is the promise of Medicare Advantage and value-based care — and the standard by which meaningful reform should ultimately be measured.