Health plan execs, buckle up. CMS continues to shake things up in Medicare Advantage (MA). Are you ready to sniff out opportunities or are you about to “Hem and Haw” your way into irrelevance?
In 1896, Charles Dow created the Dow Jones index, a group of 12 industry titans that dominated their economic sectors. Since GE dropped out of the Dow Jones index in 2018, none of the twelve firms still remain in the index. With AI infused in every nook and cranny, we are once again reminded that like the firms constituting the Dow, change is constant. In Spencer Johnson’s classic 1992 parable, Who Moved My Cheese, readers are confronted with how change is inevitable and so damnably disrupting.
That inevitability extends to our $4.4 Trillion health care sector. With the implementation of the provisions in the Inflation Reduction Act, particularly the requirement to fill the donut hole, we’ve observed firms mimicking the actions of Hem, Haw, Sniff and Scurry [principal characters in Who Moved My Cheese]. Some very smart health plans, optimized for success in Medicare Advantage, are Sniffing around for additional dual eligibles to add to their enrollment and increase their profitability (yes, the government over-indexes payments for Duals1).
There are approximately 13 million Americans who are Duals and 40% of them are under the age of 67, but qualify for Medicare based on more than 24 months of disabled status. So, getting back to Spencer’s parable, sniffing MA plans2 see opportunity in adding Duals through Annual Enrollment Period (AEP), which began on October 15th and extends into the first week in December. Other MA plans are scurrying about claiming that the sky is falling and that they need to shut down unprofitable markets and exit certain geographic regions.
“Hem and Haw” MA plans aren’t likely to escape their indecisiveness. Perhaps challenging CMS’s latest STAR ratings in court will delay the inevitable (This seems to be the strategy embraced by Alignment, SCAN, Humana and United). There is another option to consider, however.
When “Single Payer” was all the rage in smoke-filled vestibules on Capitol Hill and creating deer-in-the-headlights indecision, smart health plans were dismissing the notion and seeking to expand their membership. They were rewarded for taking the path less traveled. There are often good reasons for bucking consensus. Look to Healthrageous if you intend to double down on the vast amount of chronic disease in the Duals population. We are convinced that increasing our footprint with Duals will be amply rewarded in MA policymaking.
Our brand of supplemental benefits, starting with prepared meals to entice Duals to choose better nutrition, has created a loyal following that endorses the health plan sponsors, smart enough to invest in health. After all, isn’t that what health maintenance organizations (HMOs) were meant to do? We retain members based on that loyalty. Our intelligent clients see seniors valuing their plans, based on our white label offering. They reduce their medical spend as they improve their management of chronic illness (see our Medex Reduction blog here). Consider following Sniff’s lead and other smart MA executives and sniff Healthrageous as a Supp Benefit for the decade to come.
So what’s the winning play? Enter Healthrageous. If you’re serious about serving the Duals population (and racking up loyalty and retention along the way), it’s time to think beyond the basics. Our supplemental benefits, from prepared meals to chronic disease management tools, are turning heads and improving health outcomes. Duals who eat better, live better—and stick with the plans smart enough to offer them real value.
Let’s face it: HMOs were designed to maintain health. We’re just here to remind everyone what that actually means. So, why not follow Sniff’s lead and check out Healthrageous? We’ll be the secret sauce in your strategy for the next decade.
1 See this article explaining the relationship between coding intensity and payments, which is why Duals, who are the most coding intense, end up with higher risk scores than is perhaps necessary
2 This graphic shows the growth of DSNP plans since 2018.
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