This post was adapted from Unlock Health’s The Link newsletter. Subscribe to The Link to get insights like this directly in your inbox.
What’s going on?
Bad behavior, poor contract yield, and reduced payments raise ethical concerns over Medicare Advantage (MA).
ICYMI
MA plans have significantly reshaped the U.S. healthcare system, providing seniors with an alternative to traditional Medicare. Since 2010, enrollment in these plans has more than doubled, and for the first time last year, more than half of the 65 million eligible Medicare members opted for MA plans.
BY THE NUMBERS (sourced from Kaiser Family Foundation)
- 41% of eligible Americans were enrolled in MA in 2021
- 51% of eligible Americans were enrolled in MA in 2023
- The projected 60% of eligible members enrolled in an MA plan by 2030 is likely to increase
- UnitedHealthcare and Humana account for 75% of MA enrollment
Add these factors up, and MA equals a trillion-dollar market.
MORALS & ETHICS
MA raises questions about its efficacy for taxpayers and the broader healthcare landscape. Insurers believe they are not being paid enough by the government to offset the costs of the benefits they provide, even with the 2025 rate increase. All the while, the government is paying insurers $83 billion more for seniors’ care in MA this year compared to traditional Medicare, estimated by the Medicare Payment Advisory Commission. In response, health plans are eliminating benefits and shrinking their networks resulting in more and more hospitals terminating MA contracts.
It is crucial that CFOs and CMOs work together with managed care teams to evaluate their managed care contracts. This partnership evaluation allows for better options for patients. Unlock Health specializes in managed care consulting including MA strategies and internal and external communication pathways for change management. Bridging this gap requires a mutual understanding of how the CFO, CMO, and managed care team can work together as a power trio. Check out Unlock Health’s webinar on CFO-CMO relationship building to learn more:
What’s The Link?
CFO, CMO, and managed care team collaboration is key to growth marketing success for the MA audience.
To address current challenges, health systems must evaluate their MA plans. This analysis allows them to optimize their managed care strategy and negotiate favorable contracts for both their providers and patients. Unlock Health SME Kevin Thilborger touches on why intracompany relationships between CFOs, CMOs, and managed care teams are so important:
“As the MA market continues to grow, it is essential for healthcare providers to stay ahead of trends and continuously adapt their strategies to meet the evolving needs of their patients and the market. By adopting a proactive and strategic approach, organizations can better navigate the complexities of the market, optimize their MA strategies, and secure a sustainable future given the ever-aging population.”
When CMOs, CFOs, and managed care teams collaborate, they can align their strategies to ensure marketing is prioritized and integrated into long-range financial and business planning. Incorporating financial metrics into marketing strategies results in effective plans that align with the organization’s overall goals.
Use the checklist below to make sure your teams are collaborating effectively:
- Develop a Measurement Framework: Work with the CFO and managed care team to create marketing metrics that align with the organization’s business goals and financial objectives. Key performance indicators (KPIs) such as cost per lead, conversion rate, and marketing-generated leads should be linked to profit. Develop a payor report card to identify plans that provide the best return with the least administrative burden.
- Commit to Data-based Decision Making: Justify marketing plans with data-driven insights into market trends and consumer behavior in addition to financial metrics like ROI and profitability. Identify key service lines that align with community and market needs. An analytical approach demonstrates the effectiveness of marketing efforts while mitigating risk and investing in areas that can attract more patients and increase potential retention.
- Optimize the Marketing Budget: Ensure that existing marketing efforts are cost-efficient. More than 85% of all TV advertisements during open enrollment consist of MA plans. We’ve seen campaign success when healthcare systems take an active stance in open enrollment, resulting in thousands of patients changing plans for better care. Even small efforts, such as auditing tools or capping spending, can lead to significant savings. Get ahead of open enrollment!
- Maintain Close Contact to Build Mutual Understanding: Develop a shared language between marketing, finance, and managed care teams to ensure effective communication and collaboration. Engage in regular conversations to understand concerns and align marketing strategies with the organization’s financial and business plan.
The Unlock Health managed care team has decades of experience with payor analytics and negotiations as well as all forms of internal and external communications for payor disputes and reconciliations. Reach out today!
The Link is an insights-focused newsletter connecting you to the latest trends driving the integrated marketing and media world forward. Previously published as The Squeeze by SPM Group, The Link is produced by Unlock Health for healthcare marketers to inform, inspire, and ignite ideas.
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