The inability to adapt to shape the future development of medical payment poses a threat to the livelihood of doctors. Whether it is the integration trend of the past 20 years, the HMO movement of the 1990s, or the evolution of capital-intensive technologies or the high-cost facility components used to provide care, doctors have long faced various direct existential threats. Perform and provide the best care-and get paid for their services. Doctors have been and will continue to be centers of care. As a result, they are ultimately at the center of fluctuations in health care costs and payment waves.
Therefore, it seems appropriate for doctors to notice the rising tide associated with Medicare Advantage (MA). Medical insurance advantage Health care plans are another way for eligible individuals to obtain Medicare Part A, Part B, and usually Part D (prescription) insurance. These insurances are “integrated” and are formulated by approved private companies in accordance with Medicare The rules provided. MA plans usually also provide dental, hearing and vision insurance and attractive out-of-pocket expenses caps. In many cases, insured patients need to use healthcare providers who participate in the plan network and service area at the lowest cost.
With the Center for Medicare and Medicaid Services (CMS) Draw MA on the path There will be more than 34 million people using it by 2023 (increased from 24 million in 2020), and it is clear that MA is not just an experiment. This is the upcoming trend of healthcare delivery and payment, and we expect the commercial market to move in this direction following the path established by the CMS and the existing MA model. This will only increase the need for clinicians to seriously participate in these new mechanisms. Livelihood depends on adaptation to evolution in a densely populated world.
Time and tide
But we have not submerged MA across the country. To say the least, adoption is inconsistent.according to Research Compiled by the Kaiser Family Foundation, the current enrollment rate ranges from 1% to 40% between states (from 1% to 70% in all counties in the United States) and will continue to be stable. Viewing the registration map led us to population centers, which was a key driver of early adoption. This makes sense. In an urban environment with more hospitals and care options, it is easier to establish a comprehensive but narrower network of sufficient suppliers. It is also easier to participate more actively in nursing management for more densely populated people. Similarly, in areas with a higher density of eligible potential customers, membership recruitment is easier due to lower customer acquisition costs (CAC).
Following the traditional adoption curve, MA is completely in the “take-off” phase of the payer, but just like Professor Everett Rodgers Famous explanation, Adoption is not diffusion. As the differences in the number of participants between states and counties and counties indicate, we have not adopted it among all populations, and we are still waiting for the overall market diffusion of the MA principle.
However, unlike the spread of failures reflected in social media technology, etc., MA will continue to exist in the healthcare sector. That’s because the part of the market that has momentum for adoption is the market side of the capital flow-it is driven by the largest payer (CMS).
The enrollment rate is expected to exceed 50% by 2028, and Federal spending It is expected to increase from US$200 billion to US$580 billion (excluding part D of medical insurance, which has become synonymous with MA). In addition, employers with a population over 65 are even transforming their workforce to promote self-insurance trends. In addition, large companies such as UHG and Humana have influence across the country (84% and 66% of all counties, respectively) and are expanding (increasing by 10% or more). Targeted new entrants such as Bright Health, Oscar, Devoted and Zing Health also took advantage of the momentum. This increasingly competitive landscape means that positioning brands and products for new members becomes critical, as does the consistency of care providers to improve satisfaction, quality, and effective care.
Let’s unravel the elements. Most of the current plans (89%) include prescription plans (Medicare Part D), and more than half of them offer plans without any premiums other than Part B premiums (approximately US$145 per month on average). Generally eligible people can choose from up to 33 plans offered by 8 different companies (some companies, such as United, offer multiple plans in specific markets). This drives the demand for market differentiation.
Differentiation
Differentiation and final performance depend on the additional welfare service products and positioning for the target population. Convincing services that go beyond traditional medical insurance include everything from mental health regulations to assisted personal health participation and telemedicine services. These services shift the location of care, provide convenience and convenience for patients, and reduce overall costs. In fact, the most common supplementary benefits affect two aspects: increasing participation and/or improving outcomes by reducing high-cost events (such as admission or readmission). You will see that this is related to the uniformity of additional services beyond the traditional medical insurance fee-for-service (FFS)-fitness, dental, vision and hearing (more than 85% of MA plans provide these additional plan components). In addition, as CMS develops its payment structure around MA, advances in care management and technology for some of the newer market entrants have become more important. Supplier alliances and partnerships as points of differentiation are more urgent than ever. Zing Health and other companies are an example of the latter point.
Zing is designed and built by minority founders, and its welfare options and service design and brand identity are aimed at specific, traditionally underserved people. Zing is part of the community it cares for and reflects its unique needs, aiming to create a unique customer experience through the equally important evolution of cooperation between care providers and care plans. Zing is not alone, because other new MA programs such as Bright Health have developed their view of providers/doctors as partners, not only for better health outcomes, but for a better overall experience. To understand why the overall experience is important, let’s explore a key part of the MA payment structure…STAR ratings.
Customer is king
Performance pass Star The rating indicates the true criteria for the success of the MA program (and ultimately the business sustainability and profitability in the field).The bonus plan brings a large part of the profit to the health plan, and the recent CMS changes mean Customer experience related indicators By 2023, 57% of the total Stars score will be determined (up 25%). Scoring now places great emphasis on participation rather than paperwork.
Historically, it has been difficult for plans with a ranking of no more than 3 stars to compete without additional funds beyond the premium. They usually enter a patient recruitment death spiral (who wants a three-star plan versus a five-star plan). To understand the impact of this on program performance, if the program is reduced from 5 stars to 4 stars, they will see “all other things being equal, each member’s income drops by 7%”. In addition, STAR performance is measured on a curve-which means that as the plan improves more, the performance standard becomes higher. In addition to being a good motivational carrot for CMS implementation, the STAR program also emphasizes the need to build a company that resonates with its members (customers) and promote meaningful participation to shape positive behavior change. Coupled with the increasing emphasis on the participating components of the STAR system, it is easy to understand why peripheral and non-traditional innovations around resonant complementary products have soared.
Consumer-centric new technology health brands innovate around meaningful services, promote health and participation, and lead the next wave of MA plans. This is why the newer MA plans to deal with its structure in a different way.
Traditionally, doctors and/or care providers in the MA field have been viewed as inputs to care provision that must be cost-managed. However, the trend in the care model has pushed the market towards partnerships rather than supervision and management. Bright Health entered the market with at least one supplier system as its main partner (their care partner program), providing care as a quarterback. We have also seen significant per capita growth and fanfare in companies such as Oak Street Health and Village MD (both companies are oriented towards supplier authorization and participation).
This emerging trend in MA is an opportunity for care providers. It goes beyond the outcome of care and provides an opportunity to reshape the way healthcare services are delivered. Through the right MA partnership, doctors can more fully participate, collaborate, and capture the value they create.
Although the innovation in this developing market is the payment structure, the ultimate dissemination is firmly in the hands of care providers. Many companies, including Zing, have shown that true cooperation between the two can achieve a profitable path. If doctors help drive the design of a new MA program around engagement and membership satisfaction, they will be able to share profits driven by happier and healthier patients-and a new value-centric healthcare system.
