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10 Dec 18 20:13

Now that we are past the Medicare Annual Enrollment Period, I thought it only fitting to write this blog post on Medicare Advantage (MA). You may recognize that tag line from the original "Got Milk?" ad campaign from many years ago and I thought it appropriate to play off that for this topic. The reason I did so is obvious – MA's phenomenal growth over the last decade and its continuing growth prospects. Let me explain:

Readers (and those who took proper advantage) of my original writings (from a former life) about ten years ago will look back on my views/predictions with a smile. Among other topics, in those writings, I discussed the impending explosive growth in Medicare Advantage. With hindsight being what it is, I am happy to see that those expectations have been realized. Medicare Advantage membership today is greater than 21 million representing slightly more than one-third of all Medicare-eligible individuals. This is approximately doubling what it was ten years ago. So as we look forward to the next ten years, with kudos to AHIP for their recent infographic on MA, here are some thoughts on Medicare Advantage that you may find interesting, going forward:

Senior products (and by extension their ecosystem) will continue to grow. While Medicare Supplement will continue to serve as a hedge and diversification tool in a product portfolio despite MACRA's influence, more growth will come from Medicare Advantage. The trick will be to balance both products in local geographies, as appropriate. In fact, if the Health Insurance Tax gets applied, this may raise some MA premiums forcing people to take a closer look at Med Sup, perhaps reigniting a new wave of growth. We will see what happens legislatively in the new Congress come January.

Risk Adjustment Data Validation (RADV) audits – that have been a long time coming – will come to pass and will reveal some interesting findings. All in all, they will help make the industry better and may yield other risk-related opportunities.

STAR ratings will continue to get updated (and sharpened) as we learn how to better manage chronic diseases, invest in artificial intelligence algorithm's etc. Big data, EHR's, interoperability and other historical challenges will continue their steady march forward. These will help improve Medicare Advantage as baby-boomers really impact the system and patient-centric care becomes more real, and at greater patient volumes. Perhaps Blockchain will also help from an administration perspective.

Medicare Advantage (and others) will make greater use of telehealth services – and in the home no less. Other in-home services will also grow dramatically. Medicare Advantage Employer Group Waiver Plans (MA-EGWP's) will continue their recent growth, assuming any regulatory changes, tax law changes etc. are manageable.

Recent market data suggests that more than 2500 MA Plans will be available for individuals to enroll in. Moreover, the average beneficiary will be able to choose from more than twenty plans offered by more than 5 firms. Many of these plans will have a zero premium.

Accountable Care Organizations (ACO's) and other forms of provider oriented risk-taking will continue their march forward. As they do so – and get more comfortable with taking on risk (so that it's not just a 4-letter word), many of them will choose to continue this march forward with MA products.

Given today's economic and premium trends and the expected ending of this economic expansion at some nearing point, zero-premium plans will be even more important than they are today. Therefore, marketing, enhancing the overall customer experience, engagement, brand recognition etc. and the analytics that will support all this, will take on ever-increasing degrees of importance; the "retail-ization" of healthcare if you will.


While I could go on and on with other points about Medicare Advantage, let me conclude by once again affirming MA's growth prospects. In fact I strongly believe that future iterations of MA will look, feel and most importantly – DO - much better for members than any past ones.


So, in conclusion, as I said above, never mind milk – got MA?


Category: Other

Location: United States


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