Dr. Mehmet Oz came with a number he wants to hit. By the end of this administration, the administrator of the Centers for Medicare & Medicaid Services told a Johns Hopkins audience, Medicare Advantage and traditional Medicare should cost the federal government the same per beneficiary. Get there, he argued, and there is no reason left to favor one program over the other on cost, leaving quality as the deciding factor, a contest he believes Medicare Advantage wins.
“I think Medicare Advantage is a force for good,” Oz said.
Oz delivered the keynote at Medicare Advantage: Rethinking Payer-Provider Relationships to Advance Health, a Johns Hopkins University Nexus Symposium hosted by the Hopkins Business of Health Initiative at the Johns Hopkins University Bloomberg Center in Washington, D.C., on April 30. The interdisciplinary initiative is directed by Dan Polsky, a Bloomberg Distinguished Professor with joint appointments at the Johns Hopkins Carey Business School and the Johns Hopkins Bloomberg School of Public Health. The invitation-only symposium convened more than 100 leaders from CMS, Congress, health plans, provider organizations, and universities for a day of working sessions.
With Medicare Advantage now covering over half of all Medicare beneficiaries and facing its largest payment recalibration in twenty years, the symposium focused on the future of payer-provider relationships.
The discussion unfolded against a broader national debate about how the United States finances care for an aging population. While Medicare and Medicaid are often discussed together, they serve distinct purposes. Medicare is a federal insurance program primarily for older adults and people with certain disabilities, while Medicaid is a joint federal-state program that provides coverage and long-term care support for people with limited income and resources. Together, the programs form the backbone of the nation's healthcare safety net and account for a substantial share of federal and state healthcare spending.
As policymakers search for ways to control costs while preserving access to care, questions about the future of Medicare Advantage have become part of a larger conversation about program funding, benefit design, and the balance between public oversight and private-sector innovation. Those debates have intensified as the Baby Boomer generation ages, increasing pressure on both Medicare and Medicaid budgets.
CMS as payer, not just regulator
Oz spent much of the keynote describing how CMS should use its leverage as the country's largest payer, not only its authority as a regulator, to move the system from volume to value. He described an agency goal of becoming “the leading payer,” building value-based options in traditional Medicare that compete with private plans.
The point, he said, is “not to beat Medicare Advantage, but to keep Medicare Advantage honest, and push it, shape it, so that it can deliver the best that it can deliver.”
In that view, Medicare Advantage is the model rather than the outlier, because it incentivizes keeping patients healthy rather than billing for volume. His parity goal follows from it: if the two programs cost the government the same, he said, the decision between them turns on quality alone.
“We want them at parity,” Oz said. “And if they’re at parity, there’s no reason for anyone to favor one over the other.”
“Medicare Advantage is not a program. It’s a promise.”
The emphasis on Medicare Advantage also reflects a longstanding policy debate over the role of private plans in publicly funded healthcare programs. Supporters argue that Medicare Advantage can improve care coordination, offer additional benefits, and create incentives for better outcomes. Critics have raised concerns about overpayments, network restrictions, and whether beneficiaries always receive the access and value promised by the program. Those competing perspectives have made Medicare Advantage one of the most closely watched components of federal healthcare policy.
The conversation about Medicare's future is also linked to challenges that extend beyond the program itself. While Medicare generally does not cover long-term custodial care, Medicaid remains the primary payer for long-term nursing home and institutional care in the United States. As a result, many older adults eventually rely on Medicaid after exhausting significant personal savings, a reality that continues to fuel debate about how the country should finance long-term care and support aging populations without overwhelming public budgets.
Oz closed with an invitation, telling the room that CMS is “open for business” and asking the researchers and innovators in front of him to bring the agency ideas and concepts to test.
The room HBHI built
Across six sessions, researchers, plan and provider leadership, policymakers, and innovators worked through the evidence on payer-provider integration and the questions facing Medicare Advantage in 2026, with faculty from across the Johns Hopkins health ecosystem represented in the initiative's work seated alongside agency staff, congressional staff, and industry leaders.
“How do we rethink the way healthcare works? Not incrementally, but fundamentally,” Polsky said in his opening remarks. “That's the question HBHI was built around.”
The symposium's discussions reflected not only questions about payer-provider relationships, but also broader challenges confronting the nation's healthcare financing system: how to improve quality, expand value-based care, maintain fiscal sustainability, and ensure that Medicare and Medicaid continue to meet the needs of Americans as demographics and healthcare costs evolve.
“This is the work HBHI is here to do,” Polsky said, “and this was the right room to do it in.”
