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Rewards Vendors Vie for MA Business as CMS Relaxes Rules

August 15, 2019

Since a 2015 CMS rule gave Medicare Advantage plans more flexibility to offer rewards and incentives programs (RI programs), the agency has continued to loosen up what was historically a limited benefit, allowing completed health risk assessments to qualify as rewardable activities starting in 2019 (RMA 3/1/18, p. 1) and now offering some flexibility around plan marketing of specific rewards and incentives (see story, p. 1). This is potentially good news for the many RI program vendors that have sprung up in recent years as health plans become more interested in incentivizing healthy behaviors that can lead to higher star ratings and HEDIS scores. AIS Health spoke with three vendors to learn more about this increasingly competitive space and how they are attempting to differentiate themselves.

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Aetna, Humana Project Major MA Enrollment Gains in 2019

August 15, 2019

Following a 16% year-to-date increase in Medicare Advantage membership reported by Anthem, Inc. last month (RMA 8/1/19, p. 1), Aetna Inc. and Humana Inc. in recent weeks posted second-quarter 2019 earnings that were aided by substantial growth in their MA segments, while Cigna Corp. expressed confidence in its ability to grow that business in 2020.

CVS Health Corp. on Aug. 7 reported a 55% year-over-year increase in consolidated adjusted operating income to $4 billion, which it mainly attributed to the November 2018 addition of Aetna Inc. and growth of the pharmacy benefit manager. The Health Care Benefits segment, which includes MA and the SilverScript Part D business, contributed $17.4 billion of revenue, which on a consolidated basis grew 35.2% to $63.4 billion as of June 30, 2019.

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Working Group Recommends New SSBCI Be Clear, Equitable

August 15, 2019

Beginning in 2020, Medicare Advantage organizations will be able to offer “non-primarily health related” items and services to certain beneficiaries through Special Supplemental Benefits for the Chronically Ill (SSBCI) established in the Bipartisan Budget Act of 2018. CMS has given plan sponsors broad discretion in developing non-medical services that were previously not allowed in MA plan bids and is allowing them to target certain benefits to individuals’ conditions and needs, but a working group of diverse stakeholders suggests that a set of “guiding principles” is needed to ensure the successful implementation of new SSBCI.

While the new benefit category provides MAOs with an “unprecedented degree of flexibility” to address social determinants of health, it “also creates challenges around benefit clarity, equity and manageability,” observes the new report, “A Turning Point in Medicare Policy: Guiding Principles for New Flexibility Under Special Supplemental Benefits for the Chronically Ill.”

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Average Base Part D Premium Continues Decline as Reinsurance Trend Stabilizes

August 15, 2019

CMS on July 30 released the Medicare Part D payment benchmarks and other bid-related information for the 2020 plan year, indicating that both the average monthly premium for basic Part D coverage and the base beneficiary premium will drop for the third consecutive year. The lowering of premiums is driven by changes in the reinsurance amount, which funds 80% of all Part D costs for beneficiary expenses above the catastrophic threshold and is seeing more modest growth after years of double-digit percentage increases, observes Shelly Brandel, a principal and consulting actuary in the Milwaukee office of Milliman, Inc. Brandel estimates the figure will be $80.80 for 2020, up slightly from $78.88 in 2019.

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News Briefs

August 15, 2019

✦After some delay, the Louisiana Dept. of Health (LDH) on Aug. 5 said it intends to contract with four Medicaid managed care organizations, down from five MCOs that currently serve the state’s 1.7 million Healthy Louisiana enrollees. LDH selected AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana (Healthy Blue — an Anthem, Inc./Amerigroup partnership with Blue Cross and Blue Shield of Louisiana), Humana Health Benefit Plan of Louisiana and UnitedHealthcare Community Plan. The awards are not final and are subject to negotiation and a protest period, which has the potential to delay the planned start date of Jan. 1, 2020. Contracts are to be executed on or about Aug. 23. CVS Health Corp.’s Aetna Better Health and Centene Corp.’s Louisiana Healthcare Connections were two incumbents not selected to renew. Centene currently has a 31% market share of the program and had the lowest technical score of all six bidders, which Jefferies analysts found to be “less than encouraging” ahead of new contract awards in Texas that are expected to be unveiled this month, according to an Aug. 8 research note from the firm.

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Zolgensma Adds Insurer Coverage Amid FDA Spanking

August 12, 2019

Novartis says its new gene therapy Zolgensma (onasemnogene abeparvovec- xioi) has coverage policies from payers representing 40% of commercial lives, and high profile news reports name Aetna Inc. and Anthem, Inc. among insurers expanding their policies to cover more patients. That’s despite a $2.125 million price tag and a mere two months on the market — and comes amid a harsh rebuke from the FDA over news that Novartis subsidiary AveXis, Inc. hid some data during the agency’s review process.

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