Plans make a push for higher Medi­care Ad­van­tage en­roll­ment

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dick­son

In­sur­ers such as Unit­edHealth Group and An­them have been work­ing hard to draw peo­ple to their Medi­care Ad­van­tage plans by boost­ing qual­ity of care and cus­tomer ser­vice—and as a re­sult, star rat­ings.

Be­cause baby boomers are ag­ing into Medi­care at a rapid clip, Medi­care Ad­van­tage, the man­aged­care ver­sion of the pro­gram, has ex­ploded, giv­ing in­sur­ers ac­cess to huge sums of tax­payer-funded rev­enue. In 2016, 31%, or 17.6 mil­lion, of Medi­care en­rollees were in a Medi­care Ad­van­tage plan, com­pared with 5.3 mil­lion in 2004, ac­cord­ing to the Kaiser Fam­ily Foun­da­tion.

Star rat­ings are usu­ally what draw con­sumers to Ad­van­tage plans. And in­sur­ers will once again see who’s gain­ing ben­e­fi­cia­ries as open en­roll­ment for Medi­care ends this week. Dur­ing the nearly two-month win­dow, Medi­care ben­e­fi­cia­ries have been able to switch from tra­di­tional Medi­care to an Ad­van­tage plan or vice versa.

For 2017, Unit­edHealth ex­pects more than 80% of its Ad­van­tage mem­ber­ship will be in plans rated four stars or higher. This year Unit­edHealth in­vested in im­prov­ing the qual­ity of its plans and shifted mem­bers into plans with bet­ter care co­or­di­na­tion and clin­i­cal pro­to­cols.

An­them ex­pects 51% of its Ad­van­tage mem­bers will be en­rolled in plans that achieve four stars or higher, CEO Joseph Swedish said in an earn­ings call last month. “The im­prove­ment is the di­rect re­sult of in­vest­ments made in the Medi­care pro­gram over the past three years,” Swedish said.

Unit­edHealth could lose its top spot if fed­eral and state reg­u­la­tors sign off on the pend­ing merger of Aetna and Hu­mana. The com­bined com­pany would be a highly rated, pow­er­ful Ad­van­tage mar­keter in the in­di­vid­ual and group seg­ments.

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