Humana and Aetna Face Potential Loss of Medicare Advantage Members: What Health Insurers Can Do to Mitigate the Impact

Introduction

The future of Medicare Advantage (MA) is uncertain for Humana and Aetna, with both companies facing the potential loss of a significant number of members due to recent negative revisions to their Star ratings. This article analyzes the current situation, explores the potential impact on Humana and Aetna, and provides strategies and tips for health insurers to address similar challenges in the future.

Background

• Medicare Advantage (MA) is a privatized alternative to traditional Medicare, offered by private health insurers.
• Star ratings are a quality assessment system used by the Centers for Medicare & Medicaid Services (CMS) to evaluate MA plans.
• Humana and Aetna are two of the largest MA insurers in the United States, with over 10 million members combined.

Recent Star Ratings Revisions

In October 2022, CMS released its annual Star ratings for MA plans. Both Humana and Aetna experienced significant declines in their overall ratings:

• Humana: Average Star rating dropped from 4.02 to 3.68
• Aetna: Average Star rating dropped from 3.93 to 3.58

Impact on Humana and Aetna

The lower Star ratings could lead to a loss of members for both Humana and Aetna. Studies have shown that beneficiaries are more likely to switch MA plans with higher Star ratings.

• Humana: Projected to lose between 200,000 and 300,000 members in 2023.
• Aetna: Projected to lose between 150,000 and 250,000 members in 2023.

Strategies for Health Insurers

To mitigate the impact of potential member losses, health insurers should consider the following strategies:

1. Improve Overall Quality

• Enhance clinical care programs to address areas where Star ratings have declined.
• Implement patient-centered initiatives to improve member satisfaction and outcomes.
• Invest in data analytics to identify quality gaps and develop targeted interventions.

2. Enhance Member Communication

• Educate members about the importance of Star ratings and how they impact their coverage.
• Provide clear and concise information about plan benefits and services.
• Offer personalized communication to address individual member needs.

3. Expand Plan Offerings

• Consider offering multiple MA plans with different benefit options and Star ratings.
• Explore partnerships with other health providers to provide specialized services.
• Innovate with new plan designs that meet the changing needs of beneficiaries.

4. Advocacy and Legislative Action

• Engage with CMS and industry stakeholders to advocate for changes in Star rating methodologies.
• Support legislation that promotes fair and equitable quality assessment systems.

5. Partnerships and Collaborations

• Collaborate with healthcare providers and organizations to improve care coordination and reduce costs.
• Explore partnerships with technology companies to enhance digital health offerings.

Tips and Tricks

• Focus on high-impact quality measures: Identify and prioritize Star rating measures that have the greatest impact on overall ratings.
• Implement evidence-based interventions: Utilize interventions supported by research and best practices to improve quality outcomes.
• Personalize member engagement: Tailor communication and outreach efforts to the individual needs and preferences of members.
• Track progress and make adjustments: Regularly monitor quality metrics and make adjustments to interventions as needed to ensure continuous improvement.

Table 1: Projected Member Losses for Humana and Aetna

Table 2: Key Star Rating Measures with the Greatest Impact

Table 3: Effective Strategies to Improve Star Ratings

Conclusion

Humana and Aetna face significant challenges due to recent Star rating revisions. By implementing the strategies and tips outlined in this article, health insurers can mitigate the impact of potential member losses and improve their position in the competitive MA marketplace.