2) The growing size of the Medicare Advantage population and rising importance of the Medicare Advantage payer
Medicare Advantage is a quickly growing segment and Medicare Advantage payers are an important target customer and partner Medtronic’s for Value Based Healthcare initiatives going forward.
Medicare Advantage (MA) is a program that originated out of the 2006 Federal Healthcare bill, allowing private insurance companies to take responsibility for Medicare patients. The private insurance companies that provide Medicare Advantage plans are paid a capitated monthly premium from CMS for each patient on that plan based on that patient’s risk score, and the payer is responsible for managing that patient’s care within that monthly premium. …show more content…
In 2015, six health plans accounted for 72% of the market (United, Humana, BCBS, Kaiser, Aetna, Cigna). Another six national plans accounted for 5% of the market, while the remaining 23% of enrollees were in plans offered by hundreds of more locally or regionally focused plans (Figure 4). The merger between Aetna and Humana would join 2 of the top 5 MA firms to become the market leader with more than 25% of the MA enrollees. Cigna and Anthem combined will be the 5th largest player with around 5% of the MA enrollees (Source: CMS, Medtronic …show more content…
They are driven to manage costs by a capitated payment structure, so many of their needs overlap with the rest of the industry (patient engagement, disease management, etc.), but they also have their own unique set of needs (accurate and timely risk scoring of their population, etc.) In contrast with Medicare FFS, Medicare Advantage offers a distinct entity interested cost and outcomes and looking for partnerships that can provide value in new ways. In these collaborations, a key criterion for MA payers will be the ability to size and scale, to eventually take on population health management (e.g., high risk heart failure, top 10% total cost of care, etc.) Medtronic can capitalize on this opportunity, strengthening our capabilities to serve as an indispensable partner to these MA plans in realizing
Medicare Advantage is a quickly growing segment and Medicare Advantage payers are an important target customer and partner Medtronic’s for Value Based Healthcare initiatives going forward.
Medicare Advantage (MA) is a program that originated out of the 2006 Federal Healthcare bill, allowing private insurance companies to take responsibility for Medicare patients. The private insurance companies that provide Medicare Advantage plans are paid a capitated monthly premium from CMS for each patient on that plan based on that patient’s risk score, and the payer is responsible for managing that patient’s care within that monthly premium. …show more content…
In 2015, six health plans accounted for 72% of the market (United, Humana, BCBS, Kaiser, Aetna, Cigna). Another six national plans accounted for 5% of the market, while the remaining 23% of enrollees were in plans offered by hundreds of more locally or regionally focused plans (Figure 4). The merger between Aetna and Humana would join 2 of the top 5 MA firms to become the market leader with more than 25% of the MA enrollees. Cigna and Anthem combined will be the 5th largest player with around 5% of the MA enrollees (Source: CMS, Medtronic …show more content…
They are driven to manage costs by a capitated payment structure, so many of their needs overlap with the rest of the industry (patient engagement, disease management, etc.), but they also have their own unique set of needs (accurate and timely risk scoring of their population, etc.) In contrast with Medicare FFS, Medicare Advantage offers a distinct entity interested cost and outcomes and looking for partnerships that can provide value in new ways. In these collaborations, a key criterion for MA payers will be the ability to size and scale, to eventually take on population health management (e.g., high risk heart failure, top 10% total cost of care, etc.) Medtronic can capitalize on this opportunity, strengthening our capabilities to serve as an indispensable partner to these MA plans in realizing