Gaining an Edge in Contracting and Credentialing with Best Practices for Medicare Advantage Plans

The Medicare Advantage landscape offers attractive opportunities for health plans looking to enter the market or expand their presence into new territories. In order to succeed, plan sponsors will need to embrace innovative technologies and proactive strategies that help them stay  ahead of the competition.

 

Introduction

 

The Medicare Advantage (MA) market is one of the most dynamic and competitive areas in the entire healthcare ecosystem. As Medicare beneficiaries search for high-quality, cost-effective care options, MA enrollment is continuing on its sharp upward trajectory, jumping an additional 9 percent between 2019 and 2020 to bring the total MA population to 24.1 million people.

Despite the fact that 4 in 10 Medicare beneficiaries are now enrolled in an MA plan, there is still plenty of room for plan sponsors to maneuver. The distribution of these beneficiaries is wildly uneven across regional and local territories, with penetration rates as high as 60 percent in one county and as low as 1 percent in the next.

The ongoing beneficiary interest in Medicare Advantage and the chance to establish a presence in low-enrollment territories brings both challenges and opportunities to health plans. From …

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Innovation is no longer optional for established health payers and digital native startups. Without revamping inefficient processes, payers risk falling behind in the race for provider participating providers and market share.
Here are the first steps payers can take on the path toward sustainable, successful innovation.

 

The health plan marketplace is evolving quickly as changing demographics, new regulations, and cutting-edge technologies sweep away the status quo. Both commercial health plans and Medicare Advantage (MA) plans are seeing increased competition for visibility and market share, especially as consumers become more and more savvy about their preferences and needs.

But are internal health plan operations innovating at the same rate? Unfortunately for many payers, the answer is “no.”

Even as an emerging class of fresh-faced, digital-first payers and direct-to-consumer (DTC) telehealth companies rises up to challenge the notion of business as usual, a worrying number of payers are still relying on manual processes and fragmented workflows for network development and maintenance. As a result, they are missing out on key opportunities and creating frustration for internal stakeholders and their external partners.

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