As leaders of aging and disability organizations, you are well aware of a fact that many other industries have only recently become aware of: the Baby Boomers are aging – and there are millions of them.
Many health plan leaders have also now started paying strategic attention to how this massive aging cohort is changing many aspects of society, culture, the economy and consumerism. Approximately 26 million Baby Boomers will age into Medicare through 2030. As they do, health plans that are looking to capture and retain market power in the Medicare Advantage (MA) space should be ready.
This is where community-based organizations (CBOs) can step in and serve as a valuable partner.
Research by the Deloitte Center for Health Solutions found that, within the Baby Boomer population there are two distinct groups: “leading-edge” and “trailing-edge.” Trailing-edge Boomers are the next wave of Medicare enrollees, while leading-edge Boomers have mostly aged into the program already. Some health plans are seeing that while trailing-edge Boomers might be more likely to select MA products, as they typically have extensive experience with employer coverage, networks, benefit designs and health plans that offer MA products, they also need to consider how this next wave differs from the last in order to capture future Medicare market share.
As one example, research suggests that many trailing-edge Boomers are retiring to different areas of the country than those chosen by leading-edge Boomers. For many in the leading-edge generation, retiring meant moving to warmer climates and states where older adults were in the majority, such as Florida and Arizona. Many areas of the country not traditionally associated with growing older have become attractive destinations for the younger wave of aging adults. Places like Boise, Idaho and Austin, Texas have seen their population of adults aged 55 to 64 explode in the last 15 years.
For that reason, many health plans may begin building up their provider networks in new areas. CBOs can be a valuable asset to health plans looking to expand in new markets. Because CBOs are trusted community partners, they can also give health plans credibility when they enter new markets if they partner with them.
Staying on top of policy and regulatory changes that affect MA plans in your communities can be important to help position yourself to capitalize on the opportunities they represent. One way to understand the MA market in your area is to use tools that breakdown enrollment by health plan. Many of those tools can be found on the US Centers for Medicare and Medicaid Services’ website HERE. It also helps to monitor the strategies of local, regional and national health plans seeking to enter your market.
Although areas of the country that were not previous retirement destinations have seen a growth in their older adult population, many older adults are also staying in their current communities – or even their current homes – as they age. (See figure below.) Health plans also may be looking for ways to help their members age in place as the demand for that arrangement rises. CBOs’ programs and solutions can complement health plans’ in-home services (like remote-monitoring solutions). This trend may also mean that CBOs will need to add new positions or staff to develop new programs to respond to the needs of plans and MA requirements.
Finally, CBOs can help health plan leaders better understand the market through data sharing and their relationships with other organizations in the community. CBOs often have long histories of locally-oriented service delivery and robust networks of on-the-ground providers. Many have earned the goodwill and trust of communities, and they know the clients they serve well. This positive community standing can be very attractive to a MA plan looking to fully understand the circumstances that impact new members’ health and well-being. One particular way for CBOs to begin fostering this kind of collaboration with plans is to invite health plan leaders to attend CBO board meetings or even serve on the board. As many CBOs who have had success working with plans and other medical providers can attest, success is built upon these kinds of strong relationships.
But, increased demand from health plans could also require some focus inward on the part of CBOs. For example, in order to be a strong partner for health plans, CBOs should have a good grasp on their operating and program costs. This can allow CBOs to more easily develop contracts with health plans. Health plans may also want to see that the organization is driven on data. If you know your costs, but have no outcomes or metrics to show why those costs are valid, it may be difficult to get a health plan on board as a partner. Moreover, understanding your clients can be critical. This goes back to the data driven component. While your staff may know the names and individual personalities of your clients, documenting these details and maintaining profiles for each individual may help you serve health plans’ needs better.
Taken together, these shifts in CBO operations speak to the wider issue of needing to prepare for and steer your organization through the culture change that often occurs when working closely with a health plan. Approached with forethought and inclusiveness, CBOs can navigate these changes skillfully and in a manner that positions them as good health plan partners.
As many of you already know, the Baby Boom wave has already arrived. To respond to this sea change while advancing their mission and continuing to grow and prosper, the time is now for CBOs to consider reviewing or developing new strategies to put in place the right collaborations moving forward.
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 Medicare Payment Advisory Commission, “The next generation of Medicare beneficiaries” in Report to the Congress: Medicare and the health care delivery system. Washington, DC: MedPAC, 2015.
 Jeffrey Spivak, “Top 10 metro areas with fastest-growing senior and presenior populations,” Urban Land, July 15, 2011.
 Jeremy Burbank, “Baby boomers & their homes: On their own terms,” Demand Institute.