Bi-annual trend analysis of payers and government agencies
shows significant growth and disruption for insurance exchange
market across multiple states
LONDON, Aug. 17,
2023 /PRNewswire/ -- Clarivate Plc (NYSE:CLVT), a
global leader in connecting people and organizations to
intelligence they can trust to transform their world, today
released findings from its bi-annual Managed Market
Surveyor™ (MMS) health plan enrollment trend analysis.
Medicaid enrollment peaked with an increase of nearly 4 million
beneficiaries in the six months leading up to January 2023, but with the rollback of expansion
policies under Covid, a downward shift in enrollment for the rest
of this year is anticipated. The MMS health plan enrollment trends
data shows multiple U.S. regions are experiencing insurance
exchange growth and disruption driven by exits from insurers with
substantial market share and entries into new geographies by
national insurers.
Increases in Medicaid and Medicare beneficiaries are providing
growth opportunities for managed care plans contracted with
government agencies. In addition, movement by insurers leaving and
entering the rapidly growing individual exchange markets is driving
significant disruption. In the commercial enrollment sector, the
exit of recent entrants to the market indicates the strength of
established national insurers.
Leveraging medical and pharmacy enrollment data from commercial,
public health exchange, Medicaid, Medicare, and dual-eligible
enrollment, paired with a bi-annual survey of more than 560 payers
and government agencies, the MMS health plan enrollment trends
analysis provides insight into payer market share and plan design
at specific geographic levels across the U.S. for the commercial
and government lives sectors. The findings enable market access and
account managers to develop and implement more informed payer
strategies at local, regional, and national levels.
Key Managed Market Surveyor health plan enrollment trends,
include:
- Commercial: Cigna Corporation, which recently rebranded
as Cigna Group, reported the largest commercial enrollment gain,
while Oscar Health and Bright Health saw large enrollment declines
as they reduced their service areas. These changes indicate the
strength of national health insurers' control over the market and
benefit design.
- Exchange: The individual insurance exchange market has
seen growth of more than 2M enrollees
as of January 2023 over the previous
six months but also disruption with the exit of Bright Health and
Friday Health Plans from multiple states – including Colorado, Nebraska, Tennessee, Texas, and New
Mexico – where one or both insurers held substantial market
shares. Leading national insurers entered the individual exchange
market in new states, including Aetna (California, Delaware, Illinois, New
Jersey), Cigna (Indiana,
South Carolina, Texas), and UnitedHealthcare (Kansas, Missouri, Mississippi, Ohio). Centene saw the largest exchange growth
with the addition of more than 1M
enrollees. As a result of these market shifts, patients will
experience change and disruption in their medical and drug
coverage.
- Medicaid: Enrollment grew significantly, with the
largest increases in California,
New York, Texas, and Illinois, where the state is shifting coverage
for many children into a new program. As of January 2023, Medicaid added 3.8M enrollees nationally over a six-month
period, reaching a new high for total beneficiaries, although the
trend is likely to reverse over the course of 2023 as Medicaid
expansion enacted during the Covid pandemic is scaled back. Most of
the growth falls under managed care plans, whose control continues
to increase.
- Medicare: Enrollment increased 1 percent as of
January 2023 over the previous six
months, reflecting the continued aging of the baby boomer
population gaining eligibility for government-sponsored coverage.
Growth of Medicare Advantage enrollment, which increased 3 percent,
continues to outpace Medicare-fee-for-service, which saw an
enrollment decline, and give more control to managed care
plans.
Padma Varrey, Vice President, Commercialization, Life
Sciences & Healthcare, Clarivate, said: "Enrollment trends
continue to give managed care organizations greater control over
government-sponsored lives while also strengthening the hand of
large national insurance carriers as the exchange market
experiences disruption. Managed Market Surveyor health plan
enrollment trends provide market access teams with critical payer
market intelligence to enable informed decision making and to help
solve healthcare's biggest challenges."
Methodology for the Managed Market Surveyor Lives Enrollment
Trends Analysis
Managed Market Surveyor (MMS) contains medical and pharmacy
enrollment for commercial, public health exchange, Medicaid,
Medicare, and dual-eligible enrollment at the national, state or
county level. MMS contains more than 15 years of historical
enrollment for trending purposes. The enrollment is sourced
from Clarivate's biannual managed care census. The census
collects enrollment from active health plans in the U.S. down to
the county level based on member residency. MMS data also
undergoes a rigorous data validation process and uses a
population-based lives model.
With market access failures a leading cause for new drugs
missing projected forecasts, it's key that market access teams
monitor and understand the shifts in the access landscape. Market
access teams, including payer account management/field sales, rely
on MMS health plan enrollment and trends to get critical data and
insights on payer market share at any geographic level across the
U.S. to inform contracting strategies and priorities with
payers.
To learn more about Managed Market Surveyor Lives Enrollment
Trends, visit: here.
About Clarivate
Clarivate™ is a leading global information services provider. We
connect people and organizations to intelligence they can trust to
transform their perspective, their work and our world. Our
subscription and technology-based solutions are coupled with deep
domain expertise and cover the areas of Academia & Government,
Life Sciences & Healthcare and Intellectual Property. For more
information, please visit www.clarivate.com.
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SOURCE Clarivate Plc