Market Disruption in Medicare Advantage Creates a Path for Innovative Solutions

The recent shake-up in the Medicare Advantage market is more than just a reshuffling of plans and members—it’s a pivotal moment for regional insurers and healthcare innovation. As highlighted in Modern Healthcare, major players like UnitedHealthcare, Aetna, and Humana are exiting underperforming Medicare Advantage markets. This shift is displacing approximately 2 million Medicare Advantage members (7% of enrollees) for 2025, a figure that represents 20 times the typical annual disruption. In states like New York, where 277,000 members (27% of enrollees) are affected, the disruption is particularly acute. Regional players, such as MetroPlusHealth and Capital District Physicians Health Plan (CDPHP), see this as an opportunity to gain market share. However, the same factors that drove national insurers to exit—high medical costs, regulatory pressures, and unprofitable member demographics—remain significant hurdles for new entrants. This disruption isn’t just a challenge—it’s an opportunity for regional insurers to redefine how they serve high-cost members. Circadian Health’s virtual-first specialty care model is designed to address exactly these situations, helping health plans manage displaced members effectively while containing costs and improving outcomes.

Regional Insurers at a Crossroads

While the influx of displaced members offers potential for growth, it also brings risks. Many of these members are likely to have complex health needs, including high-cost chronic conditions such as diabetes and heart failure. Without effective management strategies, health plans may find themselves overwhelmed by rising costs and diminished profitability.

The industry challenges cited in Modern Healthcare—such as high medical costs and unprofitable member demographics—demand innovative solutions. At Circadian Health, we provide insurers with tools and programs specifically designed to address these exact challenges. Our virtual-first specialty care solutions focus on proactive care, ensuring that health plans can navigate this disruption while delivering high-value, patient-centered care.

Circadian Health: A Scalable Solution for Managing Displaced, High-Cost Members

Circadian Health’s diabetes management and heart failure programs directly address the challenge of managing displaced, high-cost Medicare Advantage members. These members often require intensive, ongoing care, which can quickly escalate costs for health plans without the right support systems in place.

Our programs create opportunities for health plans to contain spend by:

• Delivering Proactive Care: Circadian reduces costly hospitalizations and emergency visits by focusing on early interventions, timely diagnostics, and remote monitoring. For example, our heart failure program helps stabilize members before complications arise, significantly reducing acute care costs.

• Managing Chronic Conditions Effectively: Diabetes and heart failure are among the most expensive chronic conditions to manage. Circadian’s specialized care programs improve adherence, leading to better health outcomes, such as a 22% reduction in hospitalizations and a 1.56 reduction in A1C levels for patients with uncontrolled diabetes.

• Enabling Cost Predictability: By stratifying members based on risk and tailoring interventions, Circadian helps health plans create a sustainable model for managing high-cost populations, ensuring profitability even in challenging markets.

These programs are not just about managing costs—they also ensure displaced members receive the consistent, high-quality care they need, making health plans more competitive and member-focused.

Turning Disruption into Opportunity

The current upheaval in Medicare Advantage isn’t just a problem—it’s a turning point. By partnering with Circadian Health, regional insurers can seize the opportunity to not only grow their market share but also transform the way they deliver care. Circadian’s virtual-first specialty care model addresses the needs of displaced members with chronic conditions, reducing avoidable costs while improving outcomes. With our support, health plans can confidently navigate this period of disruption, ensuring profitability and delivering value-based care to the members who need it most. At Circadian Health, it’s our mission to make healthcare more accessible, affordable, and effective—turning today’s challenges into tomorrow’s successes.