Medicare Advantage is the Future of Medicare

Introduction

Introduced in 1997 as Medicare+Choice, Medicare Advantage plans have three goals:

  • Reduce costs
  • Enhance quality of care
  • Increase choice 

And they have. Leveraging the power of the healthcare market, Medicare Advantage has reduced costs to its members by about 40% a year compared to fee-for-service beneficiaries. 

Because it works, Medicare Advantage has grown consistently–and now its growth is accelerating. In the last decade, Medicare Advantage enrollment has doubled from 13 to 28 million.1 That’s over 40% of the total Medicare enrollment of 63 million.

The simple truth is this: Medicare Advantage is becoming the dominant model for the delivery of healthcare to America’s seniors. 

You might think you’ve missed the boat if you haven’t built out your Medicare Advantage program. It’s been around for 25 years. But you’d be wrong. There’s still a wealth of opportunity. The majority of Medicare enrollees today aren’t enrolled in a Medicare Advantage plan–and about 10,000 Americans become eligible for Medicare every day.

In this ebook, you can learn how to leverage the power of data, learn how to have a holistic approach to healthcare network management, and grasp how to have stronger Medicare Advantage networks.

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Define your strategy with a market assessment

While there’s plenty of room in the market for more Medicare Advantage plans, that doesn’t mean every Medicare Advantage build will be successful. At the initial planning stage, it’s critical to assess the likelihood of success. A thorough market assessment analyzes multiple factors:

  • Overall population as well as the size of the Medicare-eligible population
  • Existing health infrastructure
  • Where primary and specialty providers exist in the market
  • How the geography of the market relates to adequacy requirements
  • Competitive market data, including information on health systems in the market

It’s critical not to get caught up in the potential of a build while overlooking warning signs at this point. For example, is there a single facility or provider group that is necessary to meet adequacy requirements? Have you done your due diligence to be sure they are open to participating with new health plans? 

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