Health Insurance Enrollment Trends for Year-End 2018

https://www.markfarrah.com/mfa-briefs/health-insurance-enrollment-trends-for-year-end-2018/

Mark Farrah Associates (MFA) assessed the latest year-over-year enrollment trends, comparing fourth quarter 2017 with fourth quarter 2018 segment membership based on data filed in statutory financial reports from the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care).  As of December 31, 2018, almost 265.2 million people received medical coverage from U.S. health insurers.  This number is down from 265.6 million, or approximately 428,000 members, from a year ago. Year-end enrollment trends indicate membership gains for Medicare Advantage (MA) and Employer Group administrative services only (ASO) business while the managed Medicaid market, Individual, and Employer Group Risk segments experienced year-over-year declines.

Segment by Segment Enrollment Trends

As of December 31, 2018, the Individual segment lost over 1.0 million members year-over-year (YOY) and the Employer Group Risk segment, including Federal Employees Health Benefit Plans (FEHBP) business, experienced a decline of approximately 897,000 members. The Employer Group ASO segment persisted as the largest source of coverage in the industry, enrolling nearly 121.6 million people. Medicare Advantage experienced moderate growth in membership as over 736,000 more seniors chose an MA plan YOY.  Managed Medicaid saw a slight decrease YOY, by more than 36,000 members.  A more in-depth look at each segment follows.

  • The Individual segment experienced a significant decline of 6.7% from 15.5 million in December 2017 to 14.5 million in December 2018. Some factors that have led to a decrease in the individual market include increased costs for providers, increased premiums for members, and the repeal of the Affordable Care Act’s (ACAs) individual mandate.
  • Managed Medicaid membership marginally declined by 0.1%, or approximately 36,000 enrollees between December 31, 2017 and December 31, 2018.  Despite the decline in membership, Medicaid continues to be the largest government-sponsored health program in the United States, measured by enrollment.
  • Medicare Advantage (MA) enrollment increased from 20.7 million as of December 31, 2017 to 21.4 million at year-end 2018 according to plan-reported statutory reports. The MA segment remained the segment leader in terms of percentage increases – consistently growing YOY.

 

 

  • Employer Group Risk membership, including Federal Employees Health Benefit Plans (FEHBP) membership, experienced a 1.5% decline between 4Q17 and 4Q18. This equates to a segment decrease of over 897,000 as more employers continue to shift towards self-funded (ASO) insurance for their employees.
  • Employer group ASO (administrative services only for self-funded business) membership grew by over 814,000 members from December 2017 to December 2018.  YOY, the increase was 0.7%, nearly offsetting the decrease in the Employer Group Risk decline at a one-to-one ratio.  MFA identified 121.6 million ASO covered lives, which encompassed 46% of total health enrollment by segment for 4Q18.

Conclusion

As of December 31, 2018, almost 265.2 million people received medical coverage from U.S. health insurers, down approximately 428,000 members from a year ago. Year-end enrollment trends indicate membership declines for a majority of the health care segments. Health care will continue to be subjected to regulatory and political pressure as the upcoming presidential election approaches.

The Individual market continues to be the most volatile health care segment. Repealing the ACA remains a controversial topic that is gaining steam as 2020 swiftly approaches. While there has yet to be a popular front runner in terms of a conservative replacement plan, Medicare for All is a progressive replacement plan that aims for public sector health insurance.  In addition, managed Medicaid has expanded under the ACA but recently work requirements have gained popularity. Managed Medicaid work requirement waivers have already been approved or are currently pending in 15 states. Currently, 37 states including the District of Columbia have chosen to expand their Medicaid programs. Although Montana is counted in the 37 expanded states, a bill is currently being discussed that would extend the current expansion cutoff date past June 30, 2019.

 

About the Data

The data used in this analysis brief was obtained from Mark Farrah Associates’ Health Coverage Portal™ database. It is important to note that MFA estimated fourth quarter 2018 enrollment for a small number of health plans that are required to report quarterly enrollment but hadn’t yet filed.  Employer group ASO figures may be estimated by Mark Farrah Associates using credible company and industry resources.  Individual, Non-Group membership reported by some carriers may include CHIP (Children’s Health Insurance Program).

These adjustments may have resulted in moderate understatement or overstatement of enrollment changes by segment. Findings reflect enrollment reported by carriers with business in the U.S. and U.S. territories.  Data sources include NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care).  As always, MFA will continue to report on important plan performance and competitive shifts across all segments.

 

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry.  Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™.  For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

Healthcare Business Strategy is a FREE monthly brief that presents analysis of important issues and developments affecting healthcare business today.  If you would like to be added to our email distribution list, please submit your email to the “Subscribe to MFA Briefs” section at the bottom of this page. 

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POPULATION HEALTH TRENDS TO WATCH, TRENDS TO QUESTION IN 2019

https://www.healthleadersmedia.com/clinical-care/population-health-trends-watch-trends-question-2019?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_190319_LDR_BRIEFING_resend%20(1)&spMailingID=15320844&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1601503618&spReportId=MTYwMTUwMzYxOAS2

Healthcare organizations cannot afford to ignore consumers in 2019, as a number of major trends shape the future of care delivery (and a number of other trends warrant more critical thinking).

This article was first published March 18, 2019, by MedPage Today.

By Joyce Frieden, news editor, MedPage Today

PHILADELPHIA — The consumer will be where it’s at for population health in 2019, David Nash, MD, MBA, said here Monday at a Population Health Colloquium sponsored by Thomas Jefferson University.

“Whatever business model empowers the consumer, wherever she is,” including at home, will spell success, according to Nash, who is dean of Jefferson’s School of Population Health. “That’s where population health must go.”

Nash noted that back in 1990, Kodak, Sears, and General Electric were the most important companies in the Dow Jones Industrial Average; all those companies have disappeared or almost disappeared today.

“If we ignore the consumer, it will be at our peril,” Nash said, citing home healthcare, telehealth, and the use of wearables among the trends to watch in the coming year.

Nash, who is a columnist for MedPage Today, also cited these other trends to watch:

  • The growth of Medicare Advantage and managed Medicaid. “These are two programs that are working,” he said. “They’re working because they deliver value — high-quality care with fewer errors — and they follow our mantra: no outcome, no income.”
  • Tax reform. “Whatever your politics are [on this issue], park it at the door,” he said. “The sugar high is over, and now we’re in a carbohydrate coma. We’ve got the biggest deficits in American history; if we continue to spend money we don’t have, what will that do to healthcare? I think it will bite us in the butt when [it] comes to the Medicare trust fund.”
  • Precision medicine and population health. “[There is a notion] that precision medicine and population health are actually kissing cousins,” said Nash. “They are inexorably linked.”
  • Continued deal-making. The CVS/Aetna, UnitedHealth Group/DaVita, and Humana’s deals with Kindred Healthcare and Curo Health Services are just some of the more recent examples, he said. And he noted, the healthcare company formed by Amazon, Berkshire Hathaway, and JPMorgan Chase now has a name: Haven. “It’s a place where they’re going to figure it all out and they’ll let us know when they do.”
  • Continued delivery system consolidation. “Big surprise there,” he said sarcastically. “The real question is will they deliver value? Will they deliver synergies?” Nash noted that his own institution is a good example of this trend, having gone from one or two hospitals 5 years ago to 16 today with another two in the works.
  • Population health technology. “The gravy train of public money into this sector will [soon] be over; now the real challenge is for the IT [information technology] systems on top of those legacy companies; can they create the patient registry information and close the feedback loop, and give doctors, nurses, and pharmacists the information they need to improve care?”
  • The rise of “population health intelligence.” “That’s our term for predictive analytics, big data, artificial intelligence, and augmented intelligence … It says we don’t want to create software writers — we want doctors, nurses, pharmacists, and others who can glean the usable information from the terabyte of information coming our way, to [know how to interpret it].”
  • Pharmaceutical industry disruption. “This is really under the thumb of consumers … It’s all about price, price, price,” Nash said. “We’ve got to find a way to rationalize the pricing system. If we don’t, we’re going to end up with price controls, and as everybody in this room with a background in this area knows, those don’t work either.”
  • More venture capital money. Nash described his recent experience at the JPMorgan Chase annual healthcare conference, where people were paying $1,000 a night for hotel rooms that would normally cost $250, and being charged $20 just to sit in the lobby of one hotel. “What was going on there? It was more private-sector venture money coming into our industry than ever before. [These investors] know that when there’s $1 trillion of waste in an industry, it’s ripe for disruption.”
  • Workforce development. This is needed for the entire industry, said Nash. “More folks know a lot more [now] about population health, quality measurement and management, Lean 6 Sigma, and improving processes and reducing waste. The only way we’re going to reduce that waste of $1 trillion is to have the right kind of workforce ready to go.”

Lawton Burns, PhD, MBA, director of the Wharton Center of Health Management and Economics at the University of Pennsylvania here, urged the audience to look critically at some of these possible trends.

“You need to look for evidence for everything you hear,” said Burns, who coauthored an article with his colleague Mark Pauly, PhD, about the need to question some of the commonly accepted principles of the healthcare business.

Some of the ideas that merit more critical thinking, said Burns and Pauly, are as follows:

  • Economies of scale
     
  • Synergy
     
  • Consolidation
     
  • Big data
     
  • Platforms
     
  • One-stop shops
     
  • Disruption
     
  • Killer apps
     
  • Consumer engagement

“I’m not saying there’s anything wrong with those 10 things, but we ought to seriously consider” whether they’re real trends, Burns said. As for moving “from volume to value” in healthcare reimbursement, that idea “is more aspiration than reality” at this point, he said. “This is a slow-moving train.”

Burns also questioned the motives behind some recent healthcare consolidations. In reality, “most providers are positioning themselves to dominate local markets and stick it to the payers — let’s be honest,” he said. “You have to think when you hear about providers doing a merger, you have to think what’s the public rationale and what’s the private rationale? The private one is [often] more sinister than you realize.”

“IF WE IGNORE THE CONSUMER, IT WILL BE AT OUR PERIL.”