By Judy Packer-Tursman
Opportunities for managed care plans abound in Medicare Advantage (MA), the popular, competitive program that seems to enjoy bipartisan support, experts tell AIS Health.
The bottom line is, “The [MA] payment rate seems OK, and there will be a lot of innovation, heavy advertising, more vertical integration,” says Stephen Wood, managing partner at Clear View Solutions, LLC. “It’s still a very robust market…and the Medicare population is growing by leaps and bounds.”
Wood, along with his partner, Kirk Twiss, describes the MA environment as “market consolidation at the top — with some states virtually dominated by two or three carriers, a few ‘ankle biters,’ and that’s it — and fragmentation, growth and specialization at the bottom.”
The latter includes local provider-sponsored startups trying to launch specialized MA products, he says. But he notes that such startups face fundamental challenges: gaining sufficient enrollment and having enough revenue to cover administrative expenses. Moreover, Twiss points out, it’s “hard to compete against national plans with so many resources.”
On the Medicare Part D side, much remains in play, Twiss notes. Due to industry consolidation and vertical integration, there won’t be independent PBMs, he says, and issues surrounding prescription drug rebates, Part D benefit design and drug pricing are all unresolved.
With MA bids for next year due in early June, Brad Piper, principal and consulting actuary for Milliman, Inc., says “In my mind, flexibility was probably one of the key drivers [of MA] in 2019, and I think we’re going to see that still in 2020.”
The MA program, by including more flexibility on supplemental benefits, is allowing what Piper calls “enticement” benefits. In addition to fitness, dental, hearing and vision benefits, plans increasingly are offering a benefit to help members purchase over-the-counter health-related items, he says, and transportation to the doctor’s office is becoming more popular.
Wood describes them as “sizzle” benefits that are “more marketing oriented than clinically oriented.” He says companies continue to assess how to deliver such benefits and develop solid 2020 bids containing them by the June deadline.
What does the future hold for MA? “At least for the next year, it’s all good news,” Twiss says. “Beyond that, things change very quickly in the health care business.”