Medicare Advantage

Growth in Medicare Advantage has become increasingly difficult to sustain. Acquisition costs are rising, competition is intensifying, and members are more willing than ever to switch plans in search of better value. A study found that 15.6% of Medicare Advantage members changed plans within one year after enrollment, and 49.2% changed plans after five years.   For many organizations, the traditional growth model of driving enrollment while offsetting ongoing member losses is no longer sustainable.  Retention is the missing…

Healthcare outcomes have never mattered more, and achieving exceptional performance has never been harder. Many mid-to-large health plans are below the 4-Star threshold in Medicare Advantage (MA). While that level of performance may seem acceptable, it can cost health plans millions.  Why the 4-Star threshold is a financial turning point  Medicare Advantage plans that fall below the 4-Star threshold forfeit eligibility for Quality Bonus Payments, which can increase federal revenue by approximately 5%. On average, these bonuses translate…