Member: RADAR on Medicare Advantage

ESRD Enrollment Creates Cost, Network Unknowns for MAOs

July 2, 2020

As Medicare Advantage plans prepare to enroll patients with end-stage renal disease (ESRD) this fall, a recent change to network adequacy measurement will give them some flexibility in how they include dialysis care in their networks. Meanwhile, a new lawsuit challenging CMS’s decision to exclude outpatient dialysis facilities from time and distance standards suggests the move could dampen enrollment of ESRD patients in MA plans, but experts say a lot will depend on how they shop and what they’re looking for in coverage this fall.

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Star Ratings Take Aim at Member Experience in ‘Huge’ Shift

With Chart: With More Than 75% of the Market, Top 10 MA-PD Payers Enroll Most Members in Highly Rated Plan

July 2, 2020

CMS, building on its multi-year theme of emphasizing member experience within Medicare Advantage (MA), is increasing the weight of member experience measures beginning with the 2021 star ratings. By the 2023 star ratings, member experience will represent nearly one-third of plans’ overall star ratings, potentially leading to a significant reshuffling of MA plans achieving bonuses, analysts say.

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Post-COVID, Centene Foresees Expansion in MA and Medicaid

July 2, 2020

Providing updated guidance three months into the COVID-19 pandemic, managed Medicaid leader Centene Corp. last month raised its full year adjusted earnings per share outlook by 20 cents at the midpoint to an EPS range of $4.76 to $4.96. And while only an estimated 7% of 2019 revenue came from Medicare, executives recently emphasized Centene’s expectation that the Medicare market will be a growth driver going forward.

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Rule Raises Questions About Telehealth, Directory Accuracy

July 2, 2020

As Medicare Advantage and other insurers report increasing use of telehealth during the COVID-19 pandemic and consider the larger role that virtual visits could play on a more permanent basis, CMS recently finalized a set of policies for 2021 giving insurers more flexibility to design their provider networks, including supplementing them with telehealth. But one expert says it’s too soon to say how much telehealth will be utilized in the long term and that more information is needed to determine whether a reduction in network adequacy standards should apply more broadly in MA.

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News Briefs

July 2, 2020

✦ Centene Corp. said June 30 that its Illinois subsidiary, Meridian Health Plan of Illinois, Inc., agreed to acquire the membership of Next Level Health Partners, Inc. The deal calls for Meridian to transfer its 54,000 Cook County, Ill., Medicaid members who receive benefits from the Illinois Department of Healthcare and Family Services’ HealthChoice Illinois Program. NextLevel had said in June that it would close following the April collapse of a proposed deal for Molina Healthcare, Inc. to buy the plan for $50 million (RMA 4/16/20, p. 8). Centene said it provided the initial capital that NextLevel needed to obtain its HMO license at the end of 2017 and has provided operational support since then. The deal is expected to close in July 2020. Visit https://prn.to/3dLUjQh.

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