The U.S. healthcare industry is at a crossroads. The integration of technology, policy reforms, and patient-centered care will define the future of health delivery and access. Recognizing this inflection point, the HealthscapeRX Q4 report presents a thought-provoking analysis of how the sector could return to stability post-COVID-19.

Some of the questions unpacked in the report include,

1. How will health insurers manage the growing utilization of Part D, influenced by the CMS two-midnight rule?

2. What impact might potential reductions in direct provider payments from State Medicaid programs have on plan members?

3. Will the anticipated changes from the recent presidential election take immediate effect in 2025?

To find answers and access a perspective from Paul Mango, download HealthscapeRX: Quarterly Trends Steering Healthcare Strategies, Q4 2024, today!

In the third quarter of 2024, the performance of large health systems and insurers largely mirrored what they experienced earlier in the second quarter. Most insurers are still grappling with high medical loss ratios (MLRs) in their Medicare Advantage plans, losing covered lives in Medicaid due to redeterminations, even while seeing growth in their group and Affordable Care Act (ACA) commercial books. Considering the significant impact the supplemental subsidies have had on the development of the ACA segment, most insurers are publicly advocating their extensions. An interesting aspect is how large national insurers are transforming themselves.

This quarter, the furor surrounding the changes in the Part D program offered by Medicare, rightfully requires special attention.

Read about this in greater detail in this highly anticipated Healthcare Trends: Third Quarter 2024 Update by Paul Mango. Review the latest changes in U.S. healthcare, Part D updates after the Inflation Reduction Act, and more.

The second quarter of 2024 is marked by contrasts. While Medicare Advantage (MA) carriers faced increasing challenges, gains in the commercial group and individual segments balanced overall performance. The ACA marketplace significantly impacted insurers and providers this quarter, with current costs per enrollee in the exchanges being about three times the Congressional Budget Office's (CBO) initial estimates.

Our latest HealthscapeRX - Quarterly Trends Steering Healthcare Strategies, by Paul Mango, former Deputy Chief of Staff for Policy at HHS, explores three market and competitive dynamics: insurer growth in the commercial group and individual marketplace segments, the impact of the No Surprises Act, and the future of ACA marketplace participation.

As we conclude this quarter, we hope Paul Mango’s insights will help you fine-tune your strategies and enhance care in the rapidly evolving healthcare landscape.

In the rapidly expanding Medicare Advantage (MA) landscape, performance in the Stars program will serve as a pivotal differentiator among plans, influencing overall success in the competitive market. Approximately 34 million people are currently enrolled in MA plans, with 74% of them enrolled in MA-PD contracts with 4 Stars or more. Health plans that fail to develop robust strategies to enhance their rating to 4+ Stars risk decreased enrollment, financial losses, and compromised benefit offerings.

By prioritizing member experience through data-driven omnichannel engagement, empathetic human interaction, early initiative launches, and continuous improvement efforts, MA plans can differentiate themselves to drive sustainable growth in 2024 and beyond.

This guide explores the pressing challenges confronting Medicare Advantage (MA) plans as the Star Ratings methodology evolves at a rapid clip. It delves into five high impact strategies that MA plans can employ to maintain a competitive edge in this dynamic landscape.