"Americans deserve access to quality, affordable, and comprehensive health care that improves outcomes. That's what Medicare Advantage delivers." AHIP and its member companies know this. And America's seniors know this. Each year brings a new record-level enrollment and a greater percentage of seniors choosing Medicare Advantage over traditional Medicare, and all signs point to continued growth. Insurers are joining or growing their presence in the market and optimizing their offerings to provide care for seniors in new, more effective ways. They're also recognizing the changing face of aging, and developing programs that support the new older age. This Special Report explores the trends, innovations and more from this dynamic space. Find much more to explore on this topic from AHIP, and watch news in this area and from across health care each day in AHIP Solutions SmartBrief.

Growth in Medicare Advantage offerings and enrollment is having ripple effects that are expected to continue, with an estimated 42% of Medicare enrollees expected to select MA plans by 2028, up from 34% in 2018. MA members typically enjoy lower premiums, financial protection, enhanced benefits and an increasing level of choice -- a trend that's expected to continue as policymakers signal continued support for expanding the role private plans play in Medicare.

Medicare Advantage enrollment is thriving, with sign-ups expected to rise 12% from about 20 million enrollees this year to 23 million for 2019. Fourteen carriers entered the market this year, and consumers shopping this year's open enrollment had 600 more to choose from, compared with a year ago. Other interesting stats from this year's open enrollment:

• 2,734 plans are available nationwide for individual enrollment.
• The average beneficiary has 24 plans to choose from.
• 90% of all plans offered include drug coverage.

Some Medicare Advantage plans will offer a variety of added benefits starting next year, such as transportation to pharmacies, gyms and medical appointments; home-delivered meals; or safety modifications for the home such as wheelchair ramps. Medicare officials estimate 273 plans in 21 states will offer at least one of the services under expanded coverage flexibility, giving 7% of MA members access to the new benefits.

Fifty-seven percent of Medicare Advantage enrollees surveyed by HealthMine Medicare want to see their plans cover home care, second only to coverage of home modifications for medical needs, which 62% of respondents said they want. Some plans have implemented new supplemental benefits for 2019, and many more are expected to do so for the 2020 plan year.

The percentage of health care payments in the US tied to value instead of volume rose from 23% in 2015 to 34% last year, according to a Health Care Payment Learning and Action Network report. Nearly 50% of Medicare Advantage payments in 2017 were linked to value, compared with 38% in Medicare fee-for-service plans, 28% in commercial plans and 25% in Medicaid, according to the report.

Health insurance providers entering the Medicare Advantage market should pull together as much data as possible from each department to determine which operational components require attention and the right timing for market entry, and to ensure the plan is positioned for favorable star ratings, says Julia Wright, chief medical officer for Dean Plan Health. She says assigning stakeholder ownership for performance metrics, a rigorous focus on regulatory and compliance issues, collaboration and health IT have also been critical pillars of success.

A legal decision invalidating a 2014 rule requiring Medicare Advantage plans to use "reasonable diligence" to ensure member diagnosis information submitted to the CMS is accurate does not mitigate the importance of compliance programs, writes attorney Michael Kolber, and the CMS has appealed the decision. When plans report that information, they have been required for nearly two decades to certify it, and a 2016 court ruling determined that this process "has always required due diligence and good faith," according to Kolber.

Speaking at an AHIP conference, CMS Administrator Seema Verma underscored the importance of Medicare Advantage, noting it "represents value for our beneficiaries and taxpayers." She called new flexibility for plans to cover supplemental benefits such as adult day care, in-home meals and more "one of the most significant changes made to the Medicare program," but insurers say there is not yet a lot of evidence to guide development of these programs.

The CMS has proposed giving Medicare Part D plans more authority to negotiate drug prices by allowing them to exclude certain treatments in protected therapeutic classes if the prices of those drugs increase faster than the rate of inflation or if new formulations do not constitute "significant innovation." The proposal would also allow private payers to use step therapy and prior authorization to manage spending, and authorities said the changes would save taxpayers more than $692 million over a decade.

The Healthy Aging Research Network defines healthy aging as "the development and maintenance of optimal physical, mental (cognitive and emotional), spiritual, and social well-being and function in older adults," a concept that aligns well with a growing movement among seniors who label themselves "perennials" for the blossoming, active life they want. However, achievement of this vision is not simple, requiring a positive attitude, physical activity, access to healthy foods, social support and a safe community -- as well as a society that values older people.

An American Geriatrics Society paper outlines five pillars that it says support healthy aging: "promoting health, preventing injury, and managing chronic conditions; optimizing cognitive health; optimizing physical health; optimizing mental health; and facilitating social engagement." The authors advocate a common language around healthy aging that policymakers can use to outline best practices, create services to address unmet needs and ensure provision of cost-effective care.

Get a clearer picture of what health care will look like down the road. At AHIP's National Health Policy Conference (March 13 and 14 in D.C.), we'll tackle your hot-button issues. #AHIPPolicy is co-located with the National Conference on the Individual and Small Group Markets (March 14 and 15). Register today and save. Attend one or both meetings.

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