Bi-annual trend analysis of payers and government agencies shows significant growth and disruption for insurance exchange market across multiple states
London, U.K. August 17, 2023. 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.
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Director External Communications, Life Sciences & Healthcare