Growing MA Membership Requires More Provider/Network Oversight

From February 2010 through February 2011, total Medicare Advantage plan enrollment was up 7 percent. That’s significantly higher than the 5.8 percent rate from the same time frame one year earlier. The Centers for Medicare & Medicaid Services lists MA plan enrollment at 12,164,793 (as of Feb. 1, 2011), with a gain of 790,702 net new members from February 2010 to February 2011. That’s about 26 percent of the 46.4 million people who are eligible for Medicare.

Debra A. Donahue, a vice president for market analysis and online products at Mark Farrah & Associates, says, “In a nutshell, more Medicare Advantage members means greater oversight of network physicians [stricter policies and procedures], additional outcomes tracking [CMS uses quality metrics in its pay scale to plans and reports this data back to potential members], and increased need for geriatric and other specialty providers within networks.”

The more MA members a health plan has, the greater the importance of the roles of the medical director and pharmacy director, according to Donahue. “We are already seeing partnerships develop among top health plans in the Medicare marketplace with pharmaceutical manufacturers, and the medical and pharmacy directors play a pivotal role in managing these relationships.”

A recent report from Mark Farrah & Associates, which provides health plans with market data and analysis, says that there was some concern among health plans that the shorter open enrollment period and cancellation of private-fee-for-service (PFFS) plans as of January 2011 would have a negative impact on enrollment, but this was not the case.

Donahue adds that the Medicare Advantage enrollment growth rate was beginning to slow down during the 2009 open enrollment season (for effective dates in January 2010), “so it was good news for these plans to see the overall rate improving.”

She says a 7 percent growth rate is manageable for most plans and probably wouldn’t tax an insurer’s infrastructure drastically. “Some of that growth may be the result of demographics, but it also suggests that the managed Medicare model may be gaining increased acceptability by seniors,” says Donahue. That’s good news for insurers that place emphasis on this type of coverage.

The report says that from February 2010 to February 2011 the top five health plans in terms of MA growth (plans with more than 250,000 members) were WellPoint (17.7 percent), Humana (9.9 percent), UnitedHealth (8.6 percent), Highmark (6.6 percent), and Kaiser (5.4 percent). UnitedHealth and Humana together hold 33.4 percent of the MA plan market, up 0.7 percent from last year.

According to the report, there’s also been a slight drop in the number of health plans with more than 250,000 MA members.

For example, in February 2009 there were 10 plans with more than 250,000 members. That number dropped to eight in February 2010, and as of February 2011, there were only seven. Universal American, one of the eight plans with more than 250,000 MA members in 2010, dropped to 175,035 members as of February 2011.

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