As we near 2024, the healthcare sector is expecting important updates in the Medicare Advantage program. This means that health care providers will need to strategically reevaluate their employee benefit plans, both to stay relevant and to continue to offer effective care. AccessHope is at the forefront of this evolution, collaborating with health plans to navigate these changes effectively. Keep reading to learn more about the industry trends for the health plan market, and what they mean for providers.
2024 Health Plan Market Trends
#1: The Rising Impact of an Aging Population
The demographic makeup of Medicare beneficiaries is aging, which simply means there are more people who are using Medicare. This adds more pressure to the existing healthcare system.
As the portion of the population aged 85 and older grows, the demand for medical services increases significantly. On average, this age group spends twice as much on healthcare each much as people between 65 and 69. They’re also three times as likely to be categorized with at least one hierarchical condition.
Because of this older demographic, healthcare providers need to come up with proactive and innovative ways to meet their needs and keep them healthy. Preventive care, for example, is helpful for preventing serious health complications that may arise later in life. Additionally, home-based care models such as “virtual hospitals” and at-home assistance are becoming more popular. These two solutions offer cost-effective ways to improve the quality of life of elderly patients. Plus, it lets them stay in their homes while they take care of their health.
#2: Medicare Advantage Regulations
The Medicare Advantage (MA) program is going to see some big rule changes in 2027, marking the most extensive updates in over 20 years. These changes will impact the financial aspects, risk evaluation, and quality benchmarks of Medicare.
One key change is a 1.12% cut in the MA reimbursement rate by the Centers for Medicare & Medicaid Services (CMS), which may lead to tighter budgets for health plans and could affect how they operate. Moreover, the CMS’s Risk Adjustment Data Validation (RADV) Final Rule is set to recover $4.7 billion within ten years, indicating a shift toward more precise funding based on the health risks of people in the program.
The new health equity index (HEI) in STAR ratings is set to reward contracts for high measure-level scores with low-income subsidy, dual eligible, and disabled enrollees. However, nonprofit and smaller players, including insurtech startups, may face challenges, particularly if they must implement additional regulations or experience a lower-than-expected star rating, impacting their payments. This year, only 51% of Medicare Advantage plans offering drug coverage achieved a star rating of four or more, compared to 68% the previous year.
Changes are also coming to Part D. Health plans will not be able to receive certain payments from pharmacies anymore, and they will be required to take more responsibility for the costs of certain high-cost drugs.
With these updates, health plans need to quickly adjust their strategies to continue providing quality healthcare and managing costs effectively, while also meeting new standards for health equity.
#3: Meeting Changing Member Expectations
People with MA plans now expect a level of convenience similar to what they get from top consumer companies. The ease of choosing and using an MA plan is important for keeping members satisfied for the long run.
MA plans need to make it easier for members to get through the process of picking a plan and understanding their benefits. What's one of the best ways to do that? Digital tools. These online features make signing up and managing benefits straightforward, and they provide personalized ways to communicate.
In a market that's putting more focus on what consumers want, the MA plans that can offer these smooth, easy-to-use experiences will position themselves more optimally to keep their members happy and loyal.
#4: Synergy Between Mental and Physical Health
The COVID-19 pandemic highlighted the strong connection between mental and physical health. Health care providers are now seeing how important it is to care for the whole person, both their mental and physical health.
For MA plan providers, this means potentially broadening coverage to include more comprehensive mental health services, facilitating better access to care, and addressing mental health needs in a more proactive way in an effort to reduce long-term healthcare costs.
How Can Health Plans Adapt to a Changing Environment?
As healthcare continues to evolve, it's vital for healthcare providers to stay current with the latest technological advances and ensure they're delivering top-quality care. Timely and precise care is particularly crucial for patient recovery. AccessHope plays a pivotal role in this aspect by linking everyday medical care with leading cancer expertise.
AccessHope brings the critical cancer knowledge from the National Cancer Institute (NCI) into the hands of patients and their local doctors. It connects them with the breakthrough treatments and understanding from NCI-Designated Comprehensive Cancer Centers. This means that patient care plans are informed by the most recent and advanced cancer treatment knowledge, enhancing the likelihood of the best health outcomes.
To understand how AccessHope can transform your health plan's approach to cancer treatment and to become a part of this compassionate ecosystem of care, we invite you to learn more and join us in this mission at AccessHope for Health Plans.
