The 2024 March Healthcare Classic runner-up, Evolution of Medicare Advantage (1), is making headlines as predicted by our Selection Committee.
As MA heads into its annual enrollment period this October, beneficiaries are facing increased challenges and strains caused by the evolving market. With increased regulations from CMS, smaller base payments, and rising healthcare costs, the enrollment process will be more complicated. Adding to the complexities, the presidential election and the late Thanksgiving holiday may delay decision-making until the final week, causing additional stress for enrollees.
Our three things that matter:
1. Regulatory and financial pressures are causing major shifts in the MA market. In June, the Office of Inspector General (OIG) announced its intentions to audit MA plans; many were accused of denying post-acute care even in instances where beneficiaries qualified for such healthcare services. With increased scrutiny from the government and rising healthcare costs, MA plans are eliminating certain benefits while exiting less profitable markets. Earlier this week, Humana announced it would exit 13 MA markets. Meanwhile, CVS Health has also downgraded its geographic presence—potentially poised to lose up to 10% of its current MA members.
2. Following increased pressure, tensions are rising between MA plans and the government. The industry is undertaking a seven-figure lobbying campaign to advocate for the importance of MA. This includes digital ads, social media campaigns, and encouraging older adults to share their positive MA experiences with policymakers. While this is not a new tactic, it remains to be seen whether it will counter negative press including fraud allegations and prior authorization denials.
3. As competition increases, MA plans will need to appeal to beneficiaries’ needs amidst these changes. Not surprisingly, beneficiaries will prioritize stability in benefits when choosing a plan. To stand out, MA plans need to offer exceptional service quality and prioritize effectiveness. Despite downsizing their market presence, a strong emphasis on quality and comprehensive offerings will be crucial for attracting and keeping members.
How can MA plans effectively balance reduced market access and the elimination of benefits with the need to maintain high-quality offerings for beneficiaries? What strategies should be implemented to address these challenges?
Sources: Becker's Healthcare and Healthcare Dive
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