MA Arbitrage Is Collapsing
- Axis Growth Partners
- 6 days ago
- 2 min read
CMS Made It Official.
Medicare is undergoing a structural shift most healthcare operators and healthtech companies are misreading.
This isn’t a policy tweak.It’s the collapse of the economic arbitrage that made Medicare Advantage dominant for a decade.
And CMS is now absorbing that power directly.
The Real Shift: CMS Is Repricing Risk Without Intermediaries
The ACCESS model is being described as “just another pilot.”
That framing is wrong.
ACCESS does three things MA plans historically controlled:
Puts up to 50% of provider revenue at risk based on outcomes
Allows direct beneficiary enrollment, bypassing ACO gatekeeping
Operates in open networks, where inefficiency can’t be hidden
This is Star Ratings logic — without the MA buffer.
For the first time, Traditional Medicare is learning to price performance directly.
Why MA Is Pulling Back (Not Innovating)
The earnings calls told the truth markets already understand.
UnitedHealth is preparing for 1.3–1.4M MA member losses
Elevance confirmed MLRs pushing 93–94%
Benefits are being cut. Networks tightened. Growth slowed.
This is not cyclical pressure.It’s arbitrage compression.
MA isn’t dying — but its ability to subsidize inefficiency is.
Insurance Is Becoming a Utility. Platforms Are Taking Over.
Here’s the macro inversion most GTMs aren’t modeling:
MA plans are being forced to act like regulated utilities
CMS is turning Traditional Medicare into a risk platform
As that convergence accelerates:
“Extra benefits” stop differentiating
Relationships stop protecting margin
Data provenance becomes a payment prerequisite
Across MA and Part B, the rule is now the same:
If you can’t prove economic impact, you don’t get paid.
Why Most HealthTech Go-To-Markets Will Break in 2026
If your GTM still leads with:
“We help MA plans save money”
“We improve care coordination”
“We integrate into existing workflows”
You’re solving problems for buyers who no longer control pricing power.
The new buyer question is different:
“How do I design an economic system that monetizes outcomes across MA and Part B — without rebuilding my strategy every CMS cycle?”
That is not:
an RCM problem
an analytics problem
a vendor selection problem
It’s an economic architecture problem.
The Winners Will Be Built for Universal Risk
The next winners won’t optimize for MA or Part B.
They will:
Architect once, monetize everywhere
Align partners before contracts
Treat data as payment infrastructure, not insight
Build systems that survive policy shifts instead of chasing them
The first ACCESS cohort closes April 1, 2026.The migration has already started.
If your commercialization model can’t survive universal risk, it won’t survive the next CMS cycle.
Axis Growth PartnersThe future of healthtech commercialization is translating clinical insight into economic clarity
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