Enrollment considerations for new Medicare Advantage organizations

Enrollment growth is one of the most important considerations in the early years of a startup Medicare Advantage (MA) organization (MAO). Enrollment affects an MAO’s revenue and profitability and is a key driver to becoming successful. For these reasons, enrollment projections are a critical component of a new MAO’s financial pro forma. However, enrollment assumptions are difficult to develop, especially for a new MAO without any prior experience.

To better inform enrollment expectations for new MAOs, Milliman’s Kelly Backes and Julia Friedman analyzed historical enrollment experience for parent organizations new to the MA market from 2007 to 2018. They summarized results annually from an MAO’s initial startup year to its seventh year of operations (where available) and segmented this experience by population type and size.

They found:

  1. Enrollment increased with maturity, but varied widely.
  2. General enrollment organizations achieved the largest initial enrollment.
  3. Small organizations achieved significant growth with maturity.

To read more of their findings, read their article here.