Managed Medicare enrollment in Florida continues to grow at a fast pace. Statewide membership in Medicare Advantage (MA) plans now tops 1 million, up 12.7% from the number enrolled in April 2009. Penetration stands at 32%, up 3% from last year, as the pool of Medicare eligibles has grown at a slower rate than enrollment. Despite the addition of two new companies offering MA plans in the state, market consolidation observed in recent years also has continued as some companies scale back their plan offerings and discontinue coverage for out-of-state workers. 

This article was published in Medicare Business Online in May 2010. Copies are available to prospective clients on request.

Competition in the California Medicare Advantage market continues to run at a fast pace. While some firms are eliminating products and plans, others are expanding their service areas and new plans are starting up. Enrollment continues to increase as companies step in to capitalize on the opportunities that come with change, and statewide MA enrollment was above 1.66 million on March 1, 2010. The pace of growth – 4.6% since March 2009 – slowed a bit from the previous year’s 5.7% rate, but even so, penetration increased to 35.5% as enrollment growth exceeded growth in the state’s Medicare population.

This report was published in Medicare Business Online in April 2010. Copies are available on request.

As healthcare costs continue to climb and the slow U.S. economy pushes more people into medical assistance programs, states are increasing their use of care management strategies to help rein in costly Medicaid programs. A new analysis by Mark Farrah Associates (MFA), a leading data aggregator and publisher of health plan market data, confirms U.S. enrollment in managed Medicaid plans is on the rise. Total membership grew by 9.7% from June 2008 to September 2009, reaching more than 23 million.

The growth rate in Medicaid managed care plans is even stronger than the increase in total Medicaid enrollment, estimated recently at 7.5% from mid-2008 to mid-2009. Both statistics demonstrate a growing opportunity for health plans seeking to replace business lost in employer groups.

This Healthcare Business Strategy brief presents preliminary results of MFA’s Medicaid segment analysis project and discusses how states and health plans are approaching this market.

Click here to read the brief.

New Jersey is a largely suburban state with most of its population living in the New York and Philadelphia metropolitan areas. The hottest Medicare Advantage (MA) competition is in suburban New York City, where penetration is only about 12% and the state’s leading MA companies – Aetna, Horizon Blue Cross Blue Shield of New Jersey, and UnitedHealth – are waging a battle for members.

This article was published in Medicare Business Online on March 19, 2010. Copies are available on request.

Alaska is a state of contrasts. With fewer than 700,000 residents spread out over 663,000 square miles, it is the biggest but least densely populated of the 50 United States. Ranking 47^th in population, it is one of five states with uninsured rates above 20%. Its cost of living and per capita healthcare costs are among the highest in the country, and its number of private physicians per 1,000 residents is among the lowest in the United States. It has the smallest percentage of total population enrolled in Medicare, 9%, and the lowest Medicare Advantage (MA) penetration rate, 0.6%.

This article was published in February 2010 in Medicare Business Online in a series of briefs on state competition among managed Medicare plans. The challenge in preparing this brief was discussing the lack of competition in this market.

Copies of the brief are available on request.

At first glance, Medicare Advantage (MA) competition in North Carolina appears to be split between urban and rural markets, with the nation’s top MA company, UnitedHealth, leading in the cities and second-ranked Humana ahead in the rural areas. However, the statewide market picture is complicated by Blue Cross and Blue Shield of North Carolina, which competes strongly in the Triad cities of the northern Piedmont, North Carolina’s largest MA market, and runs a close third in metropolitan Charlotte, the state’s largest urban area.

This article was published in Medicare Business Online on January 15, 2010. Copies are available to prospective clients on request.

Looking at Medicare Advantage (MA) competition in Nevada today as compared with two years ago, one might think that not much has changed since the merger of Sierra Health Services and UnitedHealth Group in early 2008. Now, as then, two companies control the lion’s share of the market (although the names of the top companies have changed). However, a thorough analysis finds significant differences between market conditions now and two years ago.

This article was published in Medicare Business Online on December 30, 2009. Copies are available to prospective clients on request.

Competition among managed Medicare plans in Massachusetts is largely a local affair. Nearly 90% of all Medicare Advantage (MA) members are served by companies based in the commonwealth. The four companies with the highest enrollment are all Massachusetts-based, non-profit organizations. Three of the four – Tufts Associated Health Plans, Fallon Community Health Plan, and Harvard Pilgrim Health Care – got their starts in connection with local medical schools and health care providers.

This article was published in Medicare Business Online on November 16, 2009. Prospective clients may request a copy by using the form on the Contact page.

Amidst the turmoil of healthcare reform, fortunately the quest for real solutions to control rising healthcare costs is still alive. Several industry leaders are gaining support for reviving an innovative model called the Patient-Centered Medical Home (PCMH) that dates back to the 1960s. On the surface, the model appears to resemble the health maintenance organization (HMO) and is based on similar principles of coordinated care. On closer examination, it is clear that the PCMH is far less restrictive than traditional HMOs and could very well emerge to play a key role in the next generation of healthcare.

This email and online newsletter was published by Mark Farrah Associates on October 16, 2009.

Link to online newsletter

Tennessee is a largely rural state, where more than half of the individuals eligible for Medicare live outside the four largest population centers and 44% live in the mountains of East Tennessee. The state’s 23.1% Medicare Advantage (MA) penetration is higher than both the average rate of 20.8% and the median rate of 18.3% for the rest of the United States. MA penetration is higher in East Tennessee than the Middle or West regions of the state, which are home to its two big metropolitan areas, Nashville and Memphis. In East Tennessee, a 25-year history of provider-sponsored managed care is partly responsible for the above-average penetration rate.

This article was published in September 2009 by Mark Farrah Associates in Medicare Business Online. Copies are available on request.