People on the Move

January 18, 2019

Medicaid HMO Market Sees Potential Expansion in 2019

January 18, 2019

The number of people enrolled in Medicaid HMO plans decreased by 1.6% nationwide from December 2017 to December 2018. Of the 22 states that saw a decrease in Medicaid HMO membership, Indiana experienced the biggest drop, with 17.2% lower enrollment year over year. Looking ahead, voters in Idaho, Utah and Nebraska passed ballot initiatives in the 2018 midterm elections to expand Medicaid to residents living at less than 133% of the federal poverty level.

by Jinghong Chen & Carina Belles

The number of people enrolled in Medicaid HMO plans decreased by 1.6% nationwide from December 2017 to December 2018. Of the 22 states that saw a decrease in Medicaid HMO membership, Indiana experienced the biggest drop, with 17.2% lower enrollment year over year. Looking ahead, voters in Idaho, Utah and Nebraska passed ballot initiatives in the 2018 midterm elections to expand Medicaid to residents living at less than 133% of the federal poverty level. This move could bring coverage to more than 300,000 people in the three new states combined. Meanwhile, newly elected Maine Gov. Janet Mills (D) signed an executive order to begin implementation of the expansion that had been passed in 2017 but was delayed by the outgoing governor. See below for Medicaid HMO enrollment changes in 2018 and an overview of several key states whose November 2018 midterm results might result in major changes to their Medicaid programs in 2019.

SOURCES: AIS’s Medicare and Medicaid Market Data, as of December 2017 and December 2018. 2018 Midterm Election results as of Nov. 8, 2018; 2017 Maine referendum results as of Dec. 20, 2017. Expansion eligibility figures sourced from ballot initiative materials, local and national news reports and state Medicaid documents where available.

Datapoint: Anthem Launches New MA Partnership with CVS Pharmacy

January 17, 2019

Anthem, Inc. this week announced a new partnership with CVS Health that will allow its California Medicare Advantage members to use their health plan allowance to purchase over-the-counter drugs at CVS pharmacies statewide. Anthem currently has 112,896 Medicare Advantage members in California, 4.7% of the state’s market share.

Anthem, Inc. this week announced a new partnership with CVS Health that will allow its California Medicare Advantage members to use their health plan allowance to purchase over-the-counter drugs at CVS pharmacies statewide. Anthem currently has 112,896 Medicare Advantage members in California, 4.7% of the state’s market share.

Source: AIS’s Directory of Health Plans

2019 Outlook: Employers to Push Insurers for More Value, Innovation

January 17, 2019

In the year ahead, employer clients will be expecting a lot from their health benefit plans, including a stronger focus on behavioral health, creative uses of data and technology, and a greater emphasis on high-performing, industry experts say.

“If I was sitting on the insurer side and I was wondering what I was going to hear from my employers this year, I would be prepared to sharpen pencils or to least expect a little more competition, a little more RFP action, a little bit more pushback,” says Suzanne Taranto, a principal and consulting actuary for Milliman, Inc.

By Leslie Small

In the year ahead, employer clients will be expecting a lot from their health benefit plans, including a stronger focus on behavioral health, creative uses of data and technology, and a greater emphasis on high-performing, industry experts say.

“If I was sitting on the insurer side and I was wondering what I was going to hear from my employers this year, I would be prepared to sharpen pencils or to least expect a little more competition, a little more RFP action, a little bit more pushback,” says Suzanne Taranto, a principal and consulting actuary for Milliman, Inc.

Among the health benefit trends and themes that employers are focused on:

✦ Behavioral health.

“For so long, behavioral health has been a secondary thought, and I think that employers large and small are realizing that this is such an important area where the system is truly, truly broken,” says Renya Spak, who leads Mercer’s Center for Health Innovation. To fix it, employers are looking for “true innovation,” whether that means partnering with startups or pushing their existing partners to operate differently.

✦ High-performing provider networks.

Taranto says employers are increasingly concerned about whether they’re sending employees to the lowest-cost, highest-quality providers. Thus, they’re interested in steering employees to Centers of Excellence for episodes of care like cancer treatment and knee, hip and back surgery, she says.

✦ Social determinants of health.

“In the commercial market, I am seeing a much greater interest in addressing the social determinants of health,” Sandeep Wadhwa, M.D., tells AIS Health via email. “…I now see an increased focus on the needs of lower wage workers where the last week of the month, for example, may lead to trade-offs between medications, food, or transportation,” adds Wadhwa, former Colorado Medicaid director and now chief health officer and senior vice president of government programs and market innovation at Solera Health.

✦ Artificial intelligence.

In the employee benefits space in 2019, “it is all about AI,” Spak says. In part, that’s because there are many new tools focused on AI-powered triage — in which users enter their symptoms and answer questions, and are then given advice about, for example, whether to simply rest a sore ankle or see a doctor.

Datapoint: California to Shift Medicaid Drug Benefit to Fee-for-Service

January 16, 2019

New California Gov. Gavin Newsom (D) signed an executive order on Jan. 7 that would transform California’s Medicaid drug benefit to an entirely fee-for-service system. California currently has about 1.4 million Medicaid beneficiaries in fee-for-service, while the remaining 10.6 million are enrolled in managed care plans. California has the largest Medicaid managed care system in the country.

New California Gov. Gavin Newsom (D) signed an executive order on Jan. 7 that would transform California’s Medicaid drug benefit to an entirely fee-for-service system. California currently has about 1.4 million Medicaid beneficiaries in fee-for-service, while the remaining 10.6 million are enrolled in managed care plans. California has the largest Medicaid managed care system in the country.

Source: AIS’s Directory of Health Plans