Published on April 2, 2019
In the rapidly growing Medicare Advantage market, mid-sized regional health plans must work smarter with data to compete against the major national players. Success in acquiring, retaining, and engaging members increasingly depends on deep and timely Medicare Advantage market intelligence.
To make better decisions aligned with overall strategic goals – like driving growth, reducing costs, and improving patient outcomes – health plans must be able to answer fundamental, strategic questions. As outlined in a recent white paper published by Carrot Health, these include:
- What is your competitive position?
- Which markets should you target for entry or expansion?
- Which new products should you offer?
Volumes of data are available to inform the answers, and dashboards like Carrot Health’s MarketView Essentials make it easy to access. First, however, health plans have to understand the kind of market intelligence they actually need. Let’s dig into the right questions for Medicare Advantage health plans to ask!
Competitive position in the Medicare Advantage market
Most health plans effectively participate in many different markets at once against multiple competitors while offering a variety of products to different patient populations. To determine competitive position, health plans should consider the following:
- What are your current enrollment numbers in each market you serve?
- How is that trending?
- How do the different markets that you serve compare to one another?
- What products are working best in each market, and what do the differences imply?
- What are your competitors doing in the market?
- Who are the “winners” and “losers” in the market?
- In what areas are they expanding or contracting services?
- What products will they offer in the coming year?
- How does that differ from previous years?
- How does market saturation and opportunity vary?
- What is the composition of patient populations in your market?
- What percentage of the population is enrolled in traditional Medicare vs. Medicare Advantage plans?
- How have populations in similar markets responded to specific plans and products?
Medicare Advantage market entry/expansion
Growing in a smart, sustainable way requires plans to think about factors beyond pure volume. Long-term stability is driven by securing members who are a good fit for the plan offering. To make decisions about market entry and expansion, health plans must understand the following:
- Who is your ideal member, and what do they want?
- What is their level of clinical risk, and what does that say about the products and services they need?
- What are their utilization patterns, and how will that affect your medical loss ratio (MLR)?
- What services will members need to engage appropriately with their health and to help you achieve your Star Rating performance goals?
- What types of health plans are driving the strongest growth?
- What are the reimbursement rates for specific plan designs?
- What is the level of maturity of the market, and what opportunities does that create?
- What is the capitated rate?
- How have FFS quartiles shifted over time?
- What is the bonus potential?
- How will the future flow of members from traditional Medicare to Medicare Advantage affect overall reimbursement rates?
New product offerings for Medicare Advantage members
To achieve financial and quality goals in a particular market, a health plan must determine the most effective and appealing products to offer. Here are some of the considerations:
- What types of products do customers want to buy?
- How do specific offerings, like dental benefits or zero-dollar premiums, impact member enrollment and competitive performance?
- What is the composition of the provider mix, in terms of specialties, group or solo practitioners, affiliations, etc.?
- What services to providers offer?
- What are their performance levels?
Carrot Health’s recent white paper – The Insight Driven Health Plan: Leveraging Consumer Data in New Ways to Thrive in Medicare Advantage Markets – shows how answers to the questions outlined in this blog post come together to inform a strategy. In addition, it provides case studies and sample data points from MarketView Essentials, our analytics dashboard that enables health plans to identify consumers in the market, the products they are choosing, and the risks and opportunities involved.