Radar on Medicare Advantage

MAOs Look to Address Cognitive Decline With ‘Memory Fitness’ Benefits

February 12, 2020

Thanks to CMS expanding its definition of primarily health-related supplemental benefits for 2019 and beyond, MA insurers are now starting to look more seriously at the idea of covering cognitive training for their senior members. Although memory fitness benefits have received less attention than more-buzzworthy supplemental offerings such as nutrition, transportation or acupuncture, “the strong clinical case, plus its low cost, suggests it’s only a matter of time before it becomes a common offering,” predicts Michael Adelberg, principal with FaegreBD Consulting and a former top CMS MA official.

By Lauren Flynn Kelly

Thanks to CMS expanding its definition of primarily health-related supplemental benefits for 2019 and beyond, MA insurers are now starting to look more seriously at the idea of covering cognitive training for their senior members. Although memory fitness benefits have received less attention than more-buzzworthy supplemental offerings such as nutrition, transportation or acupuncture, “the strong clinical case, plus its low cost, suggests it’s only a matter of time before it becomes a common offering,” predicts Michael Adelberg, principal with FaegreBD Consulting and a former top CMS MA official.

Notably, UnitedHealthcare last year incorporated Posit Science’s BrainHQ games into its larger “Renew Active” fitness benefit. Although the insurer has since switched to the brain training vendor preferred by its AARP partner, Posit Science CEO Henry Mahncke, Ph.D. says the company has signed on with three new plans in 2020: Anthem, Inc., CarePartners of Connecticut and Kaiser Permanente.

Anthem’s enhancements for 2020 included adding BrainHQ brain training exercises as a component of the Health & Fitness Tracker benefit offered with many of Anthem’s affiliated MA plans, according to Anthem spokesperson Hieu Nguyen. “The brain training exercises — as well as the other supplemental benefits we offer — align with Anthem’s whole-person approach to health care,” says Nguyen.

According to Posit Science, 87% of trial participants who used its BrainHQ’s Double Decision game showed meaningful increases in targeted cognitive ability, and users continued to show significant cognitive improvements five and 10 years later even though they were not training continuously during that time. To date, more than 150 published papers have used BrainHQ as a studied intervention method, Mahncke says.

Posit Science is encouraged by the interest in its programs. “Health care can be slow. We were out talking to MA plans last year who were not aware that the rules had changed or how the supplemental benefits worked, but word really is getting out at this point and…the science is very clear that a ton of lifestyle factors affect cognitive health and dementia risk,” says Mahncke. “I’m hoping that people can see that there are actions they can take to preserve their brain health, and of course what we’re seeing associated with that is MA plans saying, ‘We’ll help you do that.’”

Kansas Works Out Medicaid Expansion Deal

January 20, 2020

Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans.

If approved, Kansas will pursue a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 funding match. The state will also seek Section 1332 waiver approval to establish a reinsurance program and Section 1115 waiver approval to transition individuals whose incomes fall between 100% and 138% of the FPL from Medicaid to the exchange no later than Jan. 1, 2022, although expansion is not dependent on those waivers.

By Lauren Flynn Kelly

Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans.

If approved, Kansas will pursue a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 funding match. The state will also seek Section 1332 waiver approval to establish a reinsurance program and Section 1115 waiver approval to transition individuals whose incomes fall between 100% and 138% of the FPL from Medicaid to the exchange no later than Jan. 1, 2022, although expansion is not dependent on those waivers. If CMS denies either waiver, full Medicaid expansion will be implemented on Jan. 1, 2021, according to a summary of the pending legislation.

Kansas would be the 37th state to expand Medicaid. Ballot initiatives are pending in Missouri and Oklahoma, while voters in Nebraska and Utah have already approved expansion. The 10 remaining non-expansion states are largely concentrated in the South.

According to a summary of the pending Kansas legislation, the compromise proposal would feature a “robust work referral program,” “modest” premiums of up to $25 per month for an individual (or $100 per family) and no lockout provisions. But the expansion deal does not include work requirements.

Compared with other states that have attempted to require able-bodied expansion enrollees to seek work or other volunteer activities or risk losing their Medicaid coverage, the Kansas tactic is “a kinder, gentler approach to work,” remarks Jerry Vitti, founder and CEO of Healthcare Financial, Inc.

In a Jan. 9 research note from Evercore ISI, securities analyst Michael Newshel noted that if the approximately 130,000 additional lives that would be covered by expansion were split evenly among the state’s three contracted MCOs — which are units of Centene Corp., CVS Health Corp.-owned Aetna and UnitedHealthcare — they would each gain roughly $250 million in annual revenues.

Uptake of New MA Supplemental Benefits Remains Modest in 2020, Report Says

December 23, 2019

Despite Medicare Advantage insurers’ enthusiasm for increased flexibility in allowable supplemental benefits and a slew of recent plan press releases touting goodies such as pest control and “Papa Pals” for the 2020 plan year, uptake of more “resource intensive” benefits geared toward seriously ill seniors remains relatively modest, according to a new report from the Duke Margolis Center for Health Policy.

The December report, “Improving Serious Illness Care in Medicare Advantage: New Regulatory Flexibility for Supplemental Benefits,” showed that a total of 507 standard MA plans in 2019 offered one of five types of benefits addressing serious illness, accounting for roughly 11% of the approximately 4,500 standard MA plans in 2019.

By Lauren Flynn Kelly

Despite Medicare Advantage insurers’ enthusiasm for increased flexibility in allowable supplemental benefits and a slew of recent plan press releases touting goodies such as pest control and “Papa Pals” for the 2020 plan year, uptake of more “resource intensive” benefits geared toward seriously ill seniors remains relatively modest, according to a new report from the Duke Margolis Center for Health Policy.

The December report, “Improving Serious Illness Care in Medicare Advantage: New Regulatory Flexibility for Supplemental Benefits,” showed that a total of 507 standard MA plans in 2019 offered one of five types of benefits addressing serious illness, accounting for roughly 11% of the approximately 4,500 standard MA plans in 2019. By contrast, 377 in 2020 offered at least one of the five benefits highlighted in the report, while no plans in 2019 offered more than one of these benefits. But that drop was mainly driven by one major carrier abandoning its caregiver support benefit for 2020. Meanwhile, about 175 plans offered at least two of these types of these benefits, according to Robert Saunders, research director and one of the report’s authors.

Despite the decrease in caregiver support, which had the greatest initial uptake of the five benefit categories in 2019, researchers saw meaningful increases for 2020 in benefits such as adult day care and palliative care that “more directly address the needs of members with serious illness.”

The study also linked the PBP data to MA enrollment figures by plan and by county to assess the geographic impacts of the policy changes. For 2020, many parts of the country do not have any plans offering new supplemental benefits, and those aimed at serious care were likely to be offered in urban counties, said the report.

Barring any major disruption, 2021 will likely be the year of growth for new flexible benefits, as it takes plans a couple years to price, test and stand up ones that will have a lasting impact, adds Saunders.

CMS Struggles With New Medicare Plan Finder ‘Glitches’

December 11, 2019

Despite a major overhaul to the Medicare Plan Finder (MPF) that was readied in time for the Annual Election Period that concluded on Dec. 7, multiple reports at press time indicated that the online tool was providing inaccurate cost estimates for users, especially relating to prescription drugs.

CMS dropped the new MPF, which reportedly cost $11 million, on Aug. 27 — just seven weeks before the Oct. 15 start of the AEP.

By Lauren Flynn Kelly

Despite a major overhaul to the Medicare Plan Finder (MPF) that was readied in time for the Annual Election Period that concluded on Dec. 7, multiple reports at press time indicated that the online tool was providing inaccurate cost estimates for users, especially relating to prescription drugs.

CMS dropped the new MPF, which reportedly cost $11 million, on Aug. 27 — just seven weeks before the Oct. 15 start of the AEP.

“At the outset, CMS did not provide enough time to test the functionality of the tool, which has led to ‘testing in real time’ with real ramifications to Medicare beneficiaries and their ability to access care,” says Amber Christ, directing attorney with Justice in Aging.

A recent Health Affairs article observed that the new MPF “explicitly emphasizes the monthly plan premium over arguably more relevant information — estimated total drug costs — which also account for expected out-of-pocket costs.” Total drug costs are “displayed in a small font amidst other information,” and the tool lists available plans starting with the lowest premiums, added the article.

“Distressed” by “the media coverage talking about ‘glitches’ or ‘malfunctions’” in the MPF, a CMS blog post dated Nov. 27 said the new tool “displays the most current and accurate information on premiums, deductibles and cost sharing that Medicare Advantage and Prescription Drug Plans provide.”

CMS also reported that the agency is not done improving the tool and has incorporated additional changes during the AEP as it receives feedback from users and stakeholders.

“We appreciate that CMS is working diligently to address problems that come up,” says Christ. “Our concern is that many people have already made decisions based on inaccurate plan finder information.”

To ensure that beneficiaries do not experience harm, Justice in Aging has asked CMS to make the Special Enrollment Period more flexible and to widely advertise its availability, she adds.

Amid Budget Standoff, North Carolina Delays Medicaid Transformation

November 27, 2019

In the middle of an epic budget standoff between the state’s Democratic governor and the Republican-controlled legislature over Medicaid expansion and teacher pay, North Carolina’s plan to transfer some 1.6 million Medicaid enrollees into managed care in February is now indefinitely delayed, the North Carolina Dept. of Health and Human Services (DHHS) said on Nov. 19.

By Lauren Flynn Kelly

In the middle of an epic budget standoff between the state’s Democratic governor and the Republican-controlled legislature over Medicaid expansion and teacher pay, North Carolina’s plan to transfer some 1.6 million Medicaid enrollees into managed care in February is now indefinitely delayed, the North Carolina Dept. of Health and Human Services (DHHS) said on Nov. 19.

Because the North Carolina General Assembly adjourned on Nov. 15 without providing the needed funds and program authority for a Feb. 1, 2020, managed care start date, said DHHS, it has suspended implementation and open enrollment, which began for part of the state in July and went statewide in October.

With an estimated annual spend of approximately $13 billion, North Carolina is the largest state in terms of Medicaid expenditures that has not yet made the move to managed care. And the five managed care organizations taking part in North Carolina’s Medicaid transformation began enrolling beneficiaries on Oct. 14.

Taylor Griffin, a spokesperson for the NC Association of Health Plans, says the MCOs are ready to go live on schedule. “Once the state approves a budget, health plans are fully prepared to serve North Carolina’s Medicaid managed care recipients,” he tells AIS Health.

AmeriHealth Caritas North Carolina, one of the insurers contracted to serve the new Medicaid program, said it “remains committed to helping North Carolina bring about its innovative plan for Medicaid transformation” and does not intend to lay off any staff, as one GOP lawmaker had suggested insurers would be forced to do.

But one industry expert cautions against the statewide implementation. “When you push everything statewide all at once, your problems tend to magnify and it becomes very, very challenging for a state to manage not just the beneficiaries — figuring out where to go, how to go, all of that — but the state to manage their five contracted [payers],” remarks Jeff Myers, former Medicaid Health Plans of America president and founder of health care consultancy OptDis.