Planning For Growth

By Regan Pennypacker

Here are three planning questions you need to ask yourself right now:

  1. Are you losing market share because you are not offering the right products or product mix?
  2. How could the profitability of your Medicare Advantage (MA) enrollment change if you expanded your service area?
  3. Is now the time to begin offering an MA plan?

There is a proven process to go about answering these questions.

The first step begins with a market analysis to assess both current and/or proposed markets. Looking at market enrollment trends and understanding the market demographics with product and premium analyses help you understand what levers are driving the market. Plus, a benefit analysis starts to show which benefits at which premium price points are most favorable.

You then want to take the results from the market assessment and build an enrollment projection to understand what the five-year trend might be with a new product at a certain benefit level and price point or how your current product might perform in a new service area.

The next step is to pressure-test your hypothesis with a financial feasibility study. Although a feasibility study is not an actuarial study, it tests whether a hypothetical benefit design could work in a target market based on the revenue and cost characteristics of that market. It also takes into account assumptions about the Centers for Medicare & Medicaid Services (CMS) payment trends, enrollment, premium, and costs.

This process allows you to make smart, informed decisions about your current or potential market without all the investment upfront. Now is the time to start planning since the Notice of Intent to Apply (NOIA) is right around the corner in November. This type of process is not a one and done! It tends to be a very iterative process to understand how to dial the levers in the market to see if you can develop additional, profitable growth. So take the time now to get it done right, or spend the money later by guessing incorrectly.


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About Diane Hollie

Diane Hollie is Senior Director of Sales, Marketing & Strategy at Gorman Health Group (GHG). In this role, she provides strategic consulting services to ensure organizations maximize their sales distribution and marketing mix. Diane brings GHG clients more than 20 years of experience in marketing, sales, and product development for Government programs. Her strong marketing, sales and compliance background has extended to providing compliance guidance for marketing, sales and customer service communications. Read more: