A new Avalere analysis finds that 28 organizations who entered the Medicare Advantage market between 2012 and 2015 currently offer plans to beneficiaries. Together, these new players offer 104 plan options, which are available to 13.6 million beneficiaries in 24 states.
“As the baby boomers become Medicare-eligible, organizations across the healthcare landscape are stepping up to compete,” said Dan Mendelson, CEO at Avalere. “In particular, health systems are playing an even larger role in the Medicare Advantage program, further blurring the lines between providers and payers.”
Indeed, recent entrants to the Medicare Advantage market include established commercial plans, as well as major health systems and provider groups. Of the 28 organizations referenced above, 15 – or 54 percent – are provider-sponsored, as shown in Figure 1 below.
Figure 1: New Provider-Sponsored Medicare Advantage Entrants, 2012-2015
Similar trends are also evident in the health insurance exchange and employer-sponsored insurance markets.
“In addition to Medicare Advantage, providers are becoming payers to compete on exchanges and serve employers,” said Elizabeth Carpenter, vice president at Avalere. “When combined with new start-ups and other options created by the Affordable Care Act, the insurance market looks increasingly diverse.”
The analysis above is part of a new Avalere brief, “New Market Entrants: Growth and Diversification in U.S. Health Insurance,” available here. The brief explores new entrants across insurance markets, including Medicare Advantage, public exchanges, and employer-sponsored insurance. In addition, it considers how delivery system innovation and technology increase the flow of information and heighten competition in the insurance marketplace.
Funding for this analysis was provided by Aetna. Avalere maintained full editorial control.
Methods
Avalere analysis of 2015 Medicare Advantage Landscape File and June 2015 Medicare Advantage Enrollment File. New Medicare Advantage entrants are parent organizations who did not contract with Medicare in 2011, but who did contract in either 2012, 2013, 2014, or 2015, and who remain under contract in 2015. Analysis does not count PACE, Cost, or Duals-Demo plans as Medicare Advantage plans.
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To speak with an expert from Avalere about this new analysis, please contact Frank Walsh at [email protected], or 504-309-5164.
Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, D.C., the firm delivers actionable insights, business intelligence tools and custom analytics for leaders in healthcare business and policy. Avalere's experts span 230 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO and the Congress), top consultancies and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. Avalere’s focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications and interactive programs, Avalere insights are accessible to a broad range of customers. For more information, visit avalere.com, or follow us on Twitter @avalerehealth.
[1] Baylor Health System entered Medicare Advantage by merging with Scott & White Healthcare.
[2] Catholic Health Initiatives entered Medicare Advantage by acquiring SoundPath.
[3] Catholic Health Partners entered Medicare Advantage by acquiring Kaiser’s business in Ohio.
