TWEET THIS
- “Better management of the sickest patients is where
the biggest opportunity is,” L.E.K. Consulting’s Bill Frack
- Medicare Advantage enrollment is projected to rise to
38 million or 50% market penetration by the end of 2025
Anthem’s acquisition of palliative care
provider Aspire Health is the latest effort by the health insurance industry to
tap further into the management of serious advanced illness and end of life
care, particularly for seniors in Medicare Advantage plans.
Last month, Humana said it is buying a 40% stake in hospice provider Curo
Health Services as part of a $1.4 billon acquisition by the insurer and private
equity firms TPG Capital and Welsh, Carson, Anderson & Stowe. And earlier
this week, Anthem said it would buy Aspire for an undisclosed
amount, saying the addition would bring the insurer’s enrollees “a unique model
that provides palliative care and support services for patients and their
families.” Anthem operates Blue Cross and Blue Shield plans in 14 states.
Health insurers see acquisitions of providers
of advanced care as fitting the growth in seniors selecting Medicare Advantage
plans that are a big revenue source for Humana, Anthem, Aetna,
Cigna, UnitedHealth Group and other insurers.
If health insurers can better manage the care
of the sickest of patients, there’s a financial reward awaiting them because
that’s where the costs can be the greatest.
“Better management of the sickest patients is where the biggest
opportunity is,” L.E.K. Consulting’s Bill Frack said. “With
risk-adjusted revenue, Medicare Advantage pays plans a lot more money to manage
those members.”
Insurers are establishing closer ties to
medical care providers and buying up doctor practices and outpatient facilities
at an unprecedented pace in hopes they can then better coordinate medical care
than the traditional fee-for-service Medicare program.
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