With Medicare Advantage open enrollment upon us, it is time to prepare for the impact of growth and shifting membership between plans. 

The Drivers of Change

• In 2026, 101 plans shed almost 2.4M Medicare Advantage members.  Most of this membership churn was absorbed by 63 plans experiencing differential market growth. 
• For 2027, Humana has announced reduction in plans and service areas impacting 600,000 – 700,000 members.  It is expected that overall membership churn will be similar to 2026.  

The Challenge

• Many of these members have unmet care needs, lack of continuous engagement around quality, and lower risk scores compared to the likely population burden of illness.  
• The 2026 member cohort starts to become measure eligible in 2027 with additional NCQA requirements around the shit to digital quality measures.  

Prepare Now to Establish Solid Foundation

• Start now to inventory sources of clinical data and ensure they are ready for the shift to digital quality and population health management requirements.
• Identify and establish new FHIR enabled end points to ensure clinical data feeds are ready from day one for new and established membership. 

We Can Help

• Velox developed the 10-10-10 process and Payer Enablement Platform to assess, analyze, and transform clinical data operations to help health plan grapple with the challenges of growth.  
• Contact us to help on this growth journey.  

This creates unique challenges for care management, quality programs, and #riskadjustment since 101 plans shed almost 2.4M members.  If your plan inherited some of these 2.4M members it is likely there are unmet care needs, lack of continuous engagement around quality, and lower risk scores compared to the likely population burden of illness.  

So, what is the small to mid-sized plan to do?

Inventory potential sources of data, stratify risk, and stream into your model of care programs to address potentially unmet needs.