Cooperating for better care.

News & Views

Study: Providers dominant among new MA groups

Share this:


Modern Healthcare reports that an Aetna-funded study by Avalere, a consulting firm, showed that providers represented almost 60 percent of  new Medicare Advantage organizations in 2016. The growth of provider-based Advantage plans has been most pronounced in the past decade,  said the study.

Avalere said it had full control of the research and that the data were based on CMS reports. But Modern Healthcare noted that “it’s likely no coincidence that Aetna is backing research that reinforces one of its arguments in favor of its $37 billion Humana acquisition.”

The publication reported that “{h}ospitals and health systems have undoubtedly raced to start their own Medicare Advantage products. Providers, especially those that have tinkered with Medicare’s Accountable Care Organizations, have become emboldened to take more risk. Becoming a Medicare Advantage insurer offers providers the biggest risk and potentially a bigger financial reward.

“But the latest Avalere study also shows that provider-based plans are still really small players so far in Medicare Advantage. The top 10 provider-based insurers by enrollment represent only 12 percent of Medicare Advantage’s nearly 18 million members—and most of those are enrolled in the dominant Kaiser Permanente system. Aetna and Humana, meanwhile, control a quarter of Medicare Advantage membership,” the publication reported.


Contact Info

(617) 230-4965

Wellesley, Mass