While Medicare Advantage organizations and Prescription Drug Plans approached this year’s Medicare Advantage bid cycle with more optimism than in recent years, few chose to pursue new flexibility around benefit uniformity requirements or incorporate additional supplemental health care benefits when submitting bids by June 4 for the 2019 plan year.
CMS in the final 2019 payment notice and Call Letter for MA and Part D plans issued new provisions around uniformity flexibility and clarified that MA plans can offer targeted cost sharing and supplemental benefits for specific enrollee populations based on health status or disease as long as similarly situated individuals are treated uniformly. CMS also included a broader definition of health-related supplemental benefits and offered additional guidance on both options in late April.
Yet very few clients pursued either option for 2019 partly because of concerns over operational readiness, according to Randall Fitzpatrick, a principal with Oliver Wyman. He adds that this doesn’t mean there isn’t great interest there for future years.
As for uniformity flexibility, “I think it is a really interesting idea and you’ll see more plans move forward with that in the future, but part of it is having the system internally to be able to clearly identify the population that is eligible for these benefits,” he says.
The increasing use of encounter data in risk scores, however, continued to challenge some plans, sources say.
“Organizations are getting better with encounter data but I’d say most still have a gap between their encounter data risk scores and their [risk adjustment payment system]-based risk scores,” says Brad Piper, a principal and consulting actuary with Milliman. “[T]his continues to be an area of focus for [MAOs] and many are working with third-party risk score vendors to shrink their gap….I’ve seen it get better but it’s still an opportunity for many organizations.”