As Medicare Benefit (MA) plans proceed to achieve beneficiaries, residence well being suppliers discover themselves at a crossroads.

For some, the enchantment of MA lies in its potential to unlock new alternatives and increase affected person attain. However for others, the prospect of navigating the complexities of MA compensation poses an enormous problem.

The variety of MA college students continues to develop, however not as rapidly as lately.

A brand new report from healthcare consultancy Chartis – in partnership with HealthScape Advisors – exhibits that the MA market grew by 1.7 million beneficiaries in 2023, a rise of 5.4%. That was significantly decrease than the report development of two.7 million final 12 months (a rise of 9.4%).

“The Medicare Benefit market continues to be rising and is a really enticing market,” Alexis Levy, managing director at HealthScape Advisors, advised Dwelling Well being Care Information. “The speed of development is slowing, however the senior inhabitants continues to be rising sooner than different inhabitants teams. Medicare Benefit continues to be an more and more widespread selection for that phase.”

For the primary time, greater than half of the nation's Medicare inhabitants was enrolled in a Medicare Benefit plan by 2023, bringing whole MA enrollment to 33 million beneficiaries out of the 65.9 million folks eligible for Medicare .

Enrollment in 26 states is now at 50% or extra in Medicare Benefit, and underpenetrated states once more noticed the biggest development charges.

One other notable knowledge level, particularly for residence care suppliers, is that Particular Wants Plan (SNP) enrollment has elevated by nearly 22%.

With SNP numbers rising by nearly 1.2 million members, these plans have grow to be a cornerstone of the MA panorama.

For residence care suppliers, this improve in SNP enrollment may current each alternatives and challenges. On the one hand, the growth of SNPs presents a possible alternative for suppliers to faucet right into a rising phase of the MA market and meet the distinctive wants of enrollees – particularly these with continual circumstances or complicated care wants.

As SNPs proceed to seize a bigger share of the MA market, suppliers would profit from aligning their service choices and care supply fashions to fulfill the altering wants of SNP enrollees, Levy mentioned.

“Suppliers who provide residence well being, major care and specialty care – who can present assist addressing a number of the extra weak members – are clearly very useful to those well being plans,” Levy mentioned.

By tailoring well being plans to the precise wants of SNP beneficiaries and dealing carefully with well being plans that provide SNP protection, residence well being suppliers can work to grow to be extra enticing companions for MA plans.

The focus of SNP enrollment among the many top-performing plans paints a aggressive image within the MA market. Suppliers looking for to take part in SNP networks could face heightened scrutiny concerning high quality metrics, care outcomes, and community suitability.

In the meantime, high quality considerations stay as MA's plans wrestle with declining star rankings. A few quarter of beneficiaries now have a subscription with lower than 4 stars.

On the identical time, enrollment in five-star plans dropped considerably.

In 2022 and 2023, 27% and 22% of all memberships, respectively, had been beneath a five-star plan. In 2024, solely 7% of members can be coated by a five-star plan.

Levy identified that Kaiser misplaced a whole star, bringing the well being plan to 4 stars, whereas UnitedHealthcare, Cigna and Elevance all noticed continued declines of their star rankings. Centene, which suffered an enormous decline in 2023, noticed its rankings stabilize.

“The variety of technical modifications this 12 months to the star score program I feel has overwhelmed some plans,” Levy mentioned. “Or they weren't essentially ready for the affect of that. Member expertise rankings, that are measured by the CAHP survey, proceed to hold a number of weight and are sometimes the place well being plans which have declined in efficiency have struggled.”