Medicare Advantage Growth Could Spell Problems for Providers

Posted in Extended Business Office Solutions (EBO), Revenue Cycle Management (RCM)

Medicare Advantage (MA) business continues to experience significant growth, increasing demand for MA plans. Despite the uncertainty surrounding health care and proposed budget cuts to the program, Medicare Advantage enrollment continues to climb and this trend is expected to continue throughout 2017 and beyond. As of February 1, 2017, total Medicare Advantage membership stood at 19,593,341, with a net gain of 1,389,665 members, year-over-year.

According to data from the Centers for Medicare and Medicaid Services (CMS), 34% of the 58 million people eligible for Medicare are enrolled in MA plans across the United States and U.S. territories. The top ten carriers covered over 68% of all Medicare Advantage enrollees as of February 1, 2017. UnitedHealth Group and Humana lead the segment with more than 4.6 and 3.3 million MA members, respectively. Aetna and Kaiser Family Foundation also command significant market share with each enrolling over 1.4 million.

This continued MA growth has the potential to exacerbate the problem of how to manage members within these high-deductible health plans. Research has found that offerings in high-deductible health plans (HDHPs) and related products are projected to grow by 11 percent per year. HDHPs have several pros and cons. They offer flexible spending options for healthier beneficiaries with a low-premium, high deductible financing design. However, HDHPs can be problematic for older and sicker beneficiaries.

These high-deductible plans are forcing healthcare providers to adopt new and unique revenue cycle management strategies. This trend of increasing high-deductible plans is expected to grow over the next several years. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressures. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through payment plans, and more. The answer for healthcare providers is to take advantage of professional outsourcing companies who have expertise in patient access management solutions that can improve patient satisfaction, while lowering their collection costs and increasing revenue. These necessary outsourcing services include:

  • Scheduling, Eligibility Verification, and Pre-Authorization
  • Patient Call Center
  • Self-pay Collections

Self-pay collection is the most critical of these services. A recent McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses. An experienced outsourced self-pay collections team leverages analytics to arrive at the best time to contact patients and their propensity to pay scores to create outbound campaigns that are patient experience-oriented, non-obtrusive, and drive higher patient connect ratios.

Don’t let high-deductible, self-pay insurance amounts wreck your revenue cycle. Work with an experienced outsourcing team that will provide your patients with flexible payment options and easy access to payment capabilities for web, phone, credit card, and e-check payments.

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