Maximum Advantage from Medicare Advantage

Providers entering the MA space— What Payers and Patients can expect?

Over the years, healthcare has become increasingly customer centric but how this will affect the payers and providers is an on-going discussion. The possibility of providers entering the insurance or Medicare Advantage (MA) space is imminent with the surge of Accountable Care Organization (ACO). ACO provides insurance opportunities to hospitals and health care systems, while still cutting costs and extending care management.However, payers have an established presence in this space, giving tough competition to providers.

Over the next five years, around 28% of providers are expected to launch private health insurance plans. Catholic Health Initiatives, MedStar Health, Piedmont Healthcare and WellStar Health System and First Carolina care have already established themselves in the insurance market and are gaining momentum.

Media is also speculating over payer-provider partnerships. However, this will not be easy as cost, global exposure and risk will also come into picture over a period of time. Some areas that providers will have to concentrate on are the quality, clinical or safety measures,claims management,billing,member enrollment, benefit plan creation, etc.

Whatever the future holds, patients are in for a win-win situation. A provider, who is also a payer, will align incentives to better manage an individual’s health and wellness. Also with the right IT systems in place, providers can easily streamline processes for enrollment, eligibility and claims to curb administrative costs.This, in turn, will lower the cost of healthcare, while competing with the existing payers.

Providers can easily survive the MA space by investing in the following areas:

The market has become very interesting. While there will be challenging times ahead for payers, good times await providers.Though it is difficult to predict the exact future of healthcare, but from the look of it we can expect better quality and cheaper patient-centric care.What the future holds in store, only time will tell!