Medicare Advantage startups primed to disrupt the status quo?

The ranks of Medicare Advantage (MA) Plans are growing not only in number, but also in sophistication, says Patrick Phillips, CEO of Cavulus, a leading technology firm that serves the MA industry.

Phillips says 14 new Medicare Advantage organizations are entering the highly competitive market this Fall as the Annual Election Period begins in October.

“Many new plans are created by groups which have a direct hand in patient care, and they seek to enhance quality and control costs while improving health,” Phillips says.

The latest MA organizations have been bolstered by new flexibility in Medicare Advantage plan and benefit design recently permitted by The Centers for Medicare & Medicaid Services (CMS). Phillips points to benefits such as transportation and in-home care, and adds, “the newcomers are often adopting creative do-it-yourself approaches to achieve better outcomes for their members.”

Phillips sees commonalities of approach by the recent crop of start-ups as they sense how boomers are beginning to interact with today’s technology. “The boomer generation has fully embraced Amazon,” Phillips says. “They’re scheduling time at the Apple Genius Bar and have higher expectations than ever regarding service.”

To excel in customer service, quality, and care, the new start-ups recognize the need for nimble, yet tailored, IT infrastructure, Phillips says. “As a result, they’re quickly making themselves very competitive by building their own solutions, and partnering with highly specialized and MA-focused companies.”

Cavulus CEO Patrick Phillips

Cavulus has been serving the MA market exclusively since 2006, and Phillips says he’s surprised to see how many insurers still survive on spreadsheets and manual data transfers. “From a technology perspective the market is prime for disruption, and some of the bigger players have a false sense of security as they continue doing things the same old way,” Phillips says.

“Just look to other industries where giants like Kodak and Compaq failed to see change coming soon enough,” Phillips warns. “The status quo in Medicare Advantage is about to be altered by new innovators.”

ABOUT CAVULUS: Cavulus is a technology driven specialist in Medicare Advantage insurance solutions. The Cavulus Cloud-based Medicare Advantage Platform (Cavulus MAP™) unifies marketing, sales and enrollment operations, and is utilized by many of America’s top insurers, including several BlueCross/BlueShield companies, UPMC Health Plan, Johns Hopkins Healthcare, Lumeris and United Healthcare. For details visit