Client Results: Benefits Optimization Plan to Lead to Novel and Competitive Benefits Submission

Key recommendations in benefits optimization and a long-term growth plan for the client.

Challenge

The client, a Medicare Advantage Organization, experienced an increase in member losses of 10-15% over the prior 4 years. The goals were to define a data-driven and market-focused approach to understand the root cause of the membership decline and then use that same data to develop benefit optimization recommendations and a future growth strategy to drive membership growth.

Solution

ProspHire conducted an in-depth analysis of the Medicare Advantage (MA) marketplace by collecting and cataloging all annual competitor benefit information from 60 plans across 14 counties, comprising1.18 million MA enrolled individuals. That analysis allowed our experts to make side-by-side benefit cost share comparisons by breaking down plans by characteristics and focus on comparing benefits of competitor plans with the highest enrollment for both HMO and PPO plan types. We then applied an analytical benefits framework to identify key attributes in the market associated with high member enrollment.

Result

The results led to key recommendations in benefits optimization and a long-term growth plan for the client that identified what product segments and counties of the Medicare Advantage marketplace can be penetrated in over the next several years. Outcomes of year one to be determined at the close of the upcoming annual enrollment period.

Deliverables

Benefit Offering Current-State Assessment – Key Findings and Recommendations
Benefits Optimization Playbook and Strategic Roadmap
Plan Benefit Design Enhancement Recommendations
Core Benefit Design Recommendations
Supplemental Benefit Recommendations
Governance and Oversight Recommendations
Membership Growth Considerations
Short- and Long-Term Strategic Roadmap

Client Overview

The client is an HMO/PPO local Medicare Advantage plan. This plan covers approximately 13k members and offers many products in the marketplace to include a variety of individual needs.