{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:08:06Z","timestamp":1790255286702,"version":"4.1.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:00:00Z","timestamp":1788566400000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Medicare Advantage (MA) plans increasingly outsource core functions to third-party vendors, a trend termed the \u201cvendorification\u201d of MA. Vendors now play major roles in star-rating maximization, risk-code capture, and prior authorization, with evidence that vendor-conducted prior authorization yields higher denial rates and more appeal reversals than reviews conducted internally by insurers. This commentary examines 3 potential challenges that may be posed by vendorification: increased federal spending through non\u2013budget-neutral risk adjustment and quality bonuses, opportunities to game medical loss ratio requirements, and weakened accountability to beneficiaries' long-term health. Potential policy responses include mandatory reporting of vendor spending and, more fundamentally, reforming the payment incentives that make revenue-generating vendor services profitable.<\/jats:p>","DOI":"10.1093\/haschl\/qxag243","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:09:45Z","timestamp":1788520185000},"source":"Crossref","is-referenced-by-count":0,"title":["The vendorification of Medicare Advantage"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4081-1751","authenticated-orcid":false,"given":"David J","family":"Meyers","sequence":"first","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3733-0244","authenticated-orcid":false,"given":"Jeffrey","family":"Marr","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,5]]},"reference":[{"key":"2026092408515320500_qxag243-B1","author":"Hallmark"},{"issue":"1","key":"2026092408515320500_qxag243-B2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.4802","article-title":"Flaws in the Medicare Advantage star ratings","volume":"6","author":"Meyers","year":"2025","journal-title":"JAMA Health Forum"},{"key":"2026092408515320500_qxag243-B3","author":"KFF"},{"issue":"1","key":"2026092408515320500_qxag243-B4","doi-asserted-by":"publisher","first-page":"107","DOI":"10.7326\/ANNALS-25-03178","article-title":"Principles of managed care: a position paper from the American College of Physicians","volume":"179","author":"Crowley","year":"2026","journal-title":"Ann Intern Med."},{"key":"2026092408515320500_qxag243-B5","author":"MedPAC"},{"key":"2026092408515320500_qxag243-B6","author":"Rucker"},{"issue":"1","key":"2026092408515320500_qxag243-B7","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1377\/hlthaff.2025.00897","article-title":"The AI arms race in health insurance utilization review: promises of efficiency and risks of supercharged flaws","volume":"45","author":"Mello","year":"2026","journal-title":"Health Aff (Millwood)"},{"key":"2026092408515320500_qxag243-B8","author":"Office of Inspector General, US Department of Health and Human Services"},{"key":"2026092408515320500_qxag243-B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2025.103055","article-title":"Algorithmic decision-making in health care: evidence from post-acute care in Medicare Advantage","volume":"104","author":"Marr","year":"2025","journal-title":"J Health Econ."},{"key":"2026092408515320500_qxag243-B10","author":"US Senate Permanent Subcommittee on Investigations"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag243\/70966397\/qxag243.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/9\/qxag243\/70966397\/qxag243.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/9\/qxag243\/70966397\/qxag243.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:51:59Z","timestamp":1790254319000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag243\/8786102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":10,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag243","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,9,1]]},"article-number":"qxag243"}}