As Medicare Advantage (MA) plans continue to gain more beneficiaries, home-based care providers find themselves at a crossroads.
For some, the allure of MA lies in its potential to unlock new opportunities and expand patient reach. Yet, for others, the prospect of navigating the complexities of MA reimbursement presents a daunting challenge.
MA enrollment continues to grow, but not as rapidly as it has in recent years.
A new report from health care advisory firm Chartis — in collaboration with HealthScape Advisors — found that the MA market grew by 1.7 million beneficiaries in 2023, a 5.4% increase. That was significantly lower than the previous year’s record growth of 2.7 million (a 9.4% increase).
“The Medicare Advantage market is still growing and is a very attractive market,” Alexis Levy, managing director at HealthScape Advisors, told Home Health Care News. “The growth rate is slowing down, but the senior population is still growing at a faster rate than other population segments. Medicare Advantage is still an increasingly popular choice for that segment.”
For the first time, 2023 saw more than half of the country’s Medicare population enrolled in a Medicare Advantage plan — bringing the total MA enrollment up to 33 million total beneficiaries out of 65.9 million Medicare-eligible individuals.
Enrollment in 26 states is now 50% or more in Medicare Advantage, and under-penetrated states again saw the greatest growth rates.
Another notable data point, especially for home health providers, is that special needs plan (SNP) enrollment grew nearly 22%.
With SNP enrollment surging by nearly 1.2 million members, these plans have emerged as a cornerstone of the MA landscape.
For home health providers, this surge in SNP enrollment could offer both opportunities and challenges. On one hand, the expansion of SNPs presents a potential avenue for providers to tap into a growing segment of the MA market and cater to the unique needs of enrollees — particularly those with chronic conditions or complex care requirements.
As SNPs continue to capture a larger share of the MA market, providers would benefit from aligning their service offerings and care delivery models to meet the evolving needs of SNP enrollees, Levy said.
“Providers who offer home health, primary care and specialty care – who can offer help to address some of the more vulnerable members – are obviously very valuable to these health plans,” Levy said.
By adapting care plans to accommodate the specific requirements of SNP beneficiaries and collaborating closely with health plans offering SNP coverage, home health providers can work to become more attractive partners for MA plans.
The concentration of SNP enrollment among top-performing plans paints a competitive picture in the MA market. Providers seeking to participate in SNP networks may face heightened scrutiny in terms of quality metrics, care outcomes and network adequacy.
Meanwhile, quality concerns remain, as MA plans grapple with declining star ratings. Approximately one quarter of beneficiaries are now enrolled in plans with less than four stars.
At the same time, five-star plan enrollment declined significantly.
In 2022 and 2023, 27% and 22% of all membership was in a five-star plan, respectively. In 2024, only 7% of membership is in a five-star plan.
Levy pointed out that Kaiser lost an entire star, bringing the health plan to four stars, while UnitedHealthcare, Cigna, and Elevance all saw continuous declines in their star rankings. Centene, which suffered a massive decline in 2023, saw its ratings stabilize.
“The number of technical changes this year to the star ratings program I think caught some plans off guard,” Levy said. “Or they weren’t necessarily prepared for the impact of that. The member experience ratings, the ones that are measured by the CAHPs survey, are still heavily weighted and they tend to be what health plans who declined in performance struggled with.”
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