Lessons from Frontier Firms for Medicare Advantage

It’s the time of year when Medicare Advantage Organizations fixate on membership growth in the highly competitive Annual Election Period beginning October 15th. Roughly 10,000 people age into Medicare daily in the United States and 50% of those people select a Medicare Advantage (MA) plan. 

Additionally, MA is attracting people who initially opted for Traditional Medicare. A new study published by Health Affairs found that, “Much of the growth experienced by MA over the last two decades can be attributed to beneficiaries switching from traditional Medicare to MA, a trend that’s accelerated in recent years.”

While the opportunity is substantial, KFF notes that, “Despite most beneficiaries having access to plans operated by several different firms, Medicare Advantage enrollment is highly concentrated among a small number of firms. Together, UnitedHealthcare and Humana account for nearly half (47%) of all Medicare Advantage enrollees nationwide.”

Standing Out From The Crowd

So how can MA organizations compete with top firms and the plethora of regional, provider-owned, university-affiliated and new tech-backed start-ups? 

The continuous benchmarking among Medicare Advantage Organizations is reflected in the uniformity of pricing, benefits, networks, and even marketing messages, but there are important clues outside of the niche. 

A recent article from Harvard Business Review highlighted four key attributes of frontier firms - the most productive businesses in the world. We took a moment to consider these elements through the lens of Medicare Advantage organizations. Food for thought: is your organization adopting the habits of high-performing firms?

They capture value from digitization. “Frontier firms set bold business goals enabled by technology. They reconfigure their organizations to digitize their operations and capture the benefits of technology, rather than augment existing ways of working. And they drive accountability for results across the organization.”

Sophisticated MA orgs utilize our solutions to capture deep marketing insights and the correlations to close ratios within their sales channels. With the data transparency provided by MediareCRM, for instance, every marketing dollar is held accountable, and each lead is directed to the individual who can most effectively close it. 

They invest in intangibles. “For many of these firms, taking a long-term perspective is critical. These investments likely create a productivity J-curve, in which the early benefits of investments are small, but compound rapidly over time to create outsized long-term value.”

We observe successful MA orgs fostering relationships that serve their holistic operation. Over the long run, intangible working relationships facilitate fine-tuned processes. This creates responsiveness to opportunities and new regulatory hurdles. The result is competitive advantage. 

They build a future-ready workforce. “Frontier firms also disproportionately secure the skilled talent they need to get the most out of technology, either by attracting top talent or by an in-house investment in employee skills.”

With few exceptions, insurers have fairly traditional ‘top down’ organizational structures. Tech-backed insurers have brought new thinking into the space, and the pandemic shed light on recruiting practices when remote work is possible. Within every MA org we’ve served, there are rock star performers who are advancing and maturing operations; they should be retained through investment, promotion, and work/life flexibility. 

They adopt a systems approach. “High-performing firms tend to be more connected to global value chains, giving them access to global markets, ideas, and talent.”

MA is a distinctly U.S.-based industry, so we think of ‘global’ in relation to the whole of our industry; from marketing analytics firms, system integrators, to clinical expertise. Top performing MA orgs tap into the talent pool within their organization, but also within their network of vendors, IT providers, subject matter experts and perhaps most importantly, feedback from the beneficiaries they serve. 

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