The Medicare Advantage migration

April 1, 2024

Market Medical Executives support providers through practice growth opportunities

The popularity of Medicare Advantage plans has soared over the past decade with health care consumers. Enrollment has more than doubled, and Medicare Advantage is now outpacing traditional Medicare in terms of growth and enrollment. In 2020, Medicare Advantage covered more than 4 in 10 Medicare beneficiaries (44 percent), or 25.7 million people with Medicare. The number and share of Medicare Advantage enrollees has increased since 2020 up 30.8 million in 2023, or 51 percent or all eligible beneficiaries.*

Driving this growth, in part, is the fact that Medicare Advantage offers affordable options for patients and covers a plethora of extras, including patient support programs for chronic conditions and life-changing supplemental benefits.

But what really sets Medicare Advantage apart is its built-in accountability system — Star ratings**— as measured by the Centers for Medicare & Medicaid Services. As providers and health plans enhance care quality to achieve higher Star ratings, patient outcomes improve. This sharpened focus on outcomes accountability is creating a seismic shift in the way providers do business. But that comes with a learning curve — a curve that can be flattened with the right support.

Learn how Cigna Healthcare Market Medical Executives (MMEs) can help your practice navigate the shift from a fee-for-service landscape to value-based, outcomes-focused care — the hallmarks of Medicare Advantage.

MMEs defined

Cigna Healthcare MMEs are physicians with a wide range of practice experience who are based in each of our Medicare Advantage markets.

“Medicare Advantage represents a very different approach to improving care delivery and health outcomes,” says Cigna Healthcare Senior Medical Director Dr. Bob Coxe. “MMEs were created to collaborate directly with providers and assist them in this transition to value-based care.”

MMEs as navigators

MMEs know providers are stretched.

“Physicians are extremely time challenged,” says Dr. Coxe. “They may have only 10 to 15 minutes to see each patient while balancing a multitude of competing demands. MMEs create strategies to help coordinate that workload. We meet them where they are.”

While value-based care improves clinical outcomes for patients with Cigna Healthcare Medicare Advantage coverage, the transition from fee-for-service can create operational issues for providers. MMEs work directly with you to help meet and navigate these challenges.

MMEs as educators

The Medicare Advantage model is designed to reimburse providers specifically on improving health outcomes. MMEs help providers create the process changes needed to drive those results.

For example, MMEs can help providers identify chronic health conditions and collaborate on individualizing care plans for those patients. Additionally, MMEs can coordinate health plan benefits to fit patient needs, ensuring that all available resources are considered when delivering care.

Cigna Healthcare MME Dr. Alla Zilbering describes her role as an interpreter of sorts, saying, “We translate the business information into clinical language for our provider practices, and then we translate clinical information into business language for our internal folks.”

MMEs as problem solvers

Providers naturally focus on individual care over aggregate data. MMEs can bridge the gap, offering a look at a practice’s big picture while bringing resources on board to help shore up areas that need it.

“Most primary care doctors are patient-facing and focused,” says Dr. Zilbering. “But MMEs can help them look at their practice as a whole. For example, how many women over age 50 have had mammograms? We can provide that information, along with support to help reach out to patients to get those preventive services scheduled.”

To underscore their commitment to community, MMEs even bring those preventive services directly to patients. Dr. Zilbering’s market sponsors neighborhood mammogram vans that screen patients sent over by area physicians, an especially effective idea in the age of COVID-19.

Dr. Zilbering sums up the win-win-win relationship between Cigna Healthcare, its MMEs, and its contracted Medicare Advantage providers, saying, “What I love about Medicare Advantage is that we can keep patients healthy and physicians financially successful. All the goals are aligned.”

MMEs as physician advocates

Finally, as physicians themselves, MMEs understand your concerns, and they can share those concerns directly with Cigna Healthcare. They’re here to serve as your advocate and collaborate with you and your practice to drive superior health outcomes.

* Kaiser Family Foundation. A Snapshot of Sources of Coverage Among Medicare Beneficiaries. Published August 14, 2023. Accessed October 26, 2023.

** Every year, the Center for Medicare & Medicaid Services (CMS) scores MA plans on a five-Star rating system measuring a range of quality metrics. These measures come from data-based sources, such as the standard Healthcare Effectiveness Data and Information Set (HEDIS®), and patient surveys such as the Consumer Assessment of Health Plan Providers and Systems (CAHPS®) survey and the Health Outcomes Survey (HOS). Cigna Healthcare works closely with participating providers to consistently improve patient experiences and boost positive survey responses, which results in better Star ratings.

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