Dual Eligibles: The New Growth Opportunities Ahead for Health Plans

Table of Contents

Introduction

Health Plan Strategies and Trends for Duals

• Dual-Eligible Market Beckons MA, Medicaid Plans, but New Initiatives Pose Questions
• House Hearing Shows Opportunity, Problems in Care for Dual Eligibles
• Plans Stress in Earnings Calls That They Are Ready for Duals
• Duals Integration Push Hits Roadblocks as Provider, Advocacy Groups Seek Slowdown
• Unknowns on Sequestration, High Court, ‘Doc Fix’ Plague Plans’ Bids Preparation
• Election Results Mean Stars Bonus Demo Is Safe, but More MA Pay Cuts Could Come

Duals Market Developments

• UnitedHealth’s Deal to Buy XLHealth Is Said to Be High Priced, Mainly About Dual SNPs
• Universal American Deal to Purchase APS May Aid on Dual Eligibles, Medicaid, Stars
• Humana-CareSource Alliance Is Biggest of Several to Sprout for Dual-Eligibles Bids
• WellPoint’s Planned Amerigroup Buy Shows Attraction of Duals Market, Consolidations
• WellCare to Buy Calif. MA Plan, Expects Growth in Dual SNPs

Special Needs Plans

• XLHealth Seeks Major Expansion in SNPs for 2012; Some Other MA Plans Stay Put
• New Integration Efforts Bolster Outlook for SNPs, but Big Financial Issues Linger
• Special Needs Plans Surge in Enrollment, but Profitability of Products Is Problematic
• MA Product Changes for 2013 Include Huge Spike in United C-SNPs, Rise in Cost Sharing

State Initiatives and Challenges

• States’ Reliance on Medicaid Managed Care Soars, Study Finds
• Duals Application Process Ends With Flurry Of Additional States Seeking OK for Demo
• Opportunities Vary Greatly by State for CMS Duals Initiatives
• Six States Are Likely to Begin Duals Demo in 2013, CMS Says
• SCAN Wrestles With State Over Alleged Medi-Cal Overpayments
• SCAN Agrees to Pay $320 Million to Resolve Overpayment Charges
• Calif. Lawmakers Are Urged to Slow Down Medicaid Move to Plans
• Calif. Finalizes Proposed Dual-Eligible Initiative, Including ‘Opt-Out’ Enrollment
• Calif. Picks Seven Plans for First Phase of Duals Initiative
• Proposed Calif. Budget Would Delay Start, Phase-in of Duals Initiative
• Mass. Gets Nod for First CMS Duals Project; Delays on Capitation Rates Worry Plans
• A Tale of Two States: Neighbors Ohio, Mich. Take Different Paths in Duals Proposals
• Ohio Scores on Duals Favor Aetna, Molina; Rockefeller, MedPAC Seek National Delays
• Texas Duals Proposal Would Favor Medicaid Plans but Require SNPs
• Texas Medicaid Expansion Yields Higher Utilization Than Expected
• CMS Approves Managed FFS Portion of Washington State Duals Proposal

Written By

This book was written by the editorial staff of AIS.

Written For

• Health plan business and financial managers (CEOs, CFOs, product and sales managers, government affairs managers)
• Executives of pharmaceutical manufacturers and PBMs
• Hospital and health system business and financial executives
• Consultants, actuaries, financial analysts and attorneys

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