Radar on Medicare Advantage

MCOs Team Up with CBOs To Address SDOH

March 11, 2019

Medicaid plans around the country have formed innovative relationships with community-based organizations (CBOs) to address social determinants of health (SDOH) such as housing instability and food insecurity.

Starting small with a local partner, putting some metrics in place to track the outcomes and then scaling a program up to serve more people in the community is a series of steps AmeriHealth Caritas District of Columbia has taken to address social determinants, said Keith Maccannon, the insurer’s director of marketing, community relations and outreach, who spoke on an SDOH-focused panel at the 12th Annual Managed Medicaid Summit.

By Lauren Flynn Kelly

Medicaid plans around the country have formed innovative relationships with community-based organizations (CBOs) to address social determinants of health (SDOH) such as housing instability and food insecurity.

Starting small with a local partner, putting some metrics in place to track the outcomes and then scaling a program up to serve more people in the community is a series of steps AmeriHealth Caritas District of Columbia has taken to address social determinants, said Keith Maccannon, the insurer’s director of marketing, community relations and outreach, who spoke on an SDOH-focused panel at World Congress’ 12th Annual Medicaid Managed Care Summit.

But being subject to evaluation early on in a partnership may be difficult for some smaller “mom and pop” organizations, weighed in Erica Lindquist, senior director of business acumen with the National Association of States United for Aging and Disabilities.

Another challenge that MCOs and their CBO partners sometimes face is around claims submission and reimbursement. Maccannon said AmeriHealth frequently uses administrative dollars to pay for services when it sees the business case for it, but that “encounter submission [by the community partner] is quite often one of the barriers to scalability.”

Adam Zolotor, M.D., president and CEO of the North Carolina Institute of Medicine, said the state has formed a task force that is thinking about ways health systems and CBOs can partner to address SDOH under North Carolina’s upcoming transformation to managed Medicaid. The state is trying to determine the various services to address SDOH that will be reimbursable and the rates to the CBOs that will offer those services, he adds.

2019 Annual Election Period Reports Higher Switch Rates in MA Program

February 25, 2019

Final 2019 Annual Election Period results demonstrate continued growth in the Medicare Advantage program, with overall membership climbing 7% from 21.5 million a year ago to 22.6 million. Changes in enrollment this year were likely due to a combination of factors, from the elimination of Medicare Cost plans in certain markets to new supplemental benefits that sweetened the deal for consumers, industry experts observe.

“Nationally it was a big year for Medicare Advantage,” says Cary Badger, principal with HealthScape Advisors. “And what was unique about this year was…a large portion [of the MA growth] was coming from both the group and the individual plans.”

By Lauren Flynn Kelly

Final 2019 Annual Election Period results demonstrate continued growth in the Medicare Advantage program, with overall membership climbing 7% from 21.5 million a year ago to 22.6 million. Changes in enrollment this year were likely due to a combination of factors, from the elimination of Medicare Cost plans in certain markets to new supplemental benefits that sweetened the deal for consumers, industry experts observe.

“Nationally it was a big year for Medicare Advantage,” says Cary Badger, principal with HealthScape Advisors. “And what was unique about this year was…a large portion [of the MA growth] was coming from both the group and the individual plans.”

The February data reflecting enrollments accepted though Jan. 4 also showed year-to-date MA enrollment growth of 4.3%. Securities analyst A.J. Rice noted this was “modestly below” last year’s year-to-date membership increase of 4.9%.

One of the market disruptors was the final phasing out of Medicare Cost plans, which the federal government required insurers to eliminate in counties where two or more MA plans are competing.

Switch rates are also up, and that may be due to the availability of new supplemental benefits.

“The primary driver of switching is usually change, such as changes in the network or coverage and premiums…but now what we’re seeing is that seniors are shopping for better coverage rather than just going to the market to see if they can get a better deal,” remarks Badger.

CMS Proposes Changes to Risk Adjustment Payment, Supplement Benefits in Draft Call Letter

February 13, 2019

CMS recently proposed several changes for Medicare Advantage and Part D plans in its 2020 Advance Notice and draft Call Letter.

Of note, observes Michael Adelberg, a principal with Faegre Baker Daniels Consulting and a former top CMS MA official, is a discussion around possible changes to the Categorical Adjustment Index. CMS for the 2017 star ratings applied this interim adjustment to address the within-contract disparity in performance associated with a contract’s makeup of low-income subsidy and dual eligible and disabled beneficiaries.

By Lauren Flynn Kelly

CMS recently proposed several changes for Medicare Advantage and Part D plans in its 2020 Advance Notice and draft Call Letter.

Of note, observes Michael Adelberg, a principal with Faegre Baker Daniels Consulting and a former top CMS MA official, is a discussion around possible changes to the Categorical Adjustment Index. CMS for the 2017 star ratings applied this interim adjustment to address the within-contract disparity in performance associated with a contract’s makeup of low-income subsidy and dual eligible and disabled beneficiaries.

“The work to further risk-adjust medication adherence measures is worth watching,” says Adelberg, referring to draft recommendations made by the Pharmacy Quality Alliance. “It could set a precedent for further risk-adjusting other measures based on socioeconomic status.”

The Call Letter also contained expected guidance on supplemental benefits targeted to beneficiaries who meet a specified definition of chronically ill. CMS proposed establishing a new, even broader category of Special Supplemental Benefits for the Chronically Ill.

“That’s an area where I think we might see some plans show interest in that additional flexibility and try to take advantage of that to create benefit offerings that are more attractive to those chronically ill members and keep them as healthy and happy as possible,” observes Brad Piper, a principal and consulting actuary with the Milwaukee office of Milliman.

In outlining new opioid policies, CMS said plans may also use new benefit flexibility to offer targeted benefits or lower cost sharing to patients with chronic pain or undergoing addiction treatment, and encouraged Part D sponsors to provide lower cost sharing for opioid-reversal agents.

CMS Proposes a 1.6% Rate Hike for MA Programs in 2020

February 11, 2019

Much of what appeared in the 2020 Advance Notice and draft Call Letter for Medicare Advantage and Part D plans was expected. And while a proposed rate increase of 1.59% may be the second highest in recent years, it may not be enough to hold down premiums if MA Prescription Drug (MA-PD) plans must comply with a new proposed Part D rule, one actuary suggests.

“Overall, we…believe it should not deter the strong enrollment growth the business has benefited from in recent years,” wrote Oppenheimer & Co., securities analyst Michael Wiederhorn. “However, investors need to be mindful that the outlook for MA plans will also be impacted by whether the HIF [health insurer fee] is delayed again for 2020, as it was for 2019.”

By Lauren Flynn Kelly

Much of what appeared in the 2020 Advance Notice and draft Call Letter for Medicare Advantage and Part D plans was expected. And while a proposed rate increase of 1.59% may be the second highest in recent years, it may not be enough to hold down premiums if MA Prescription Drug (MA-PD) plans must comply with a new proposed Part D rule, one actuary suggests.

“Overall, we…believe it should not deter the strong enrollment growth the business has benefited from in recent years,” wrote Oppenheimer & Co., securities analyst Michael Wiederhorn. “However, investors need to be mindful that the outlook for MA plans will also be impacted by whether the HIF [health insurer fee] is delayed again for 2020, as it was for 2019.”

Plans should also keep in mind that CMS has not yet completed its annual rebasing exercise, where it looks at the latest five years of available cost data, so that could impact the final rate notice due out April 1, observes Brad Piper with the Milwaukee office of Milliman. And possibly complicating things is a new HHS proposed rule that would take effect on Jan. 1, 2020, and exclude Part D rebates from safe-harbor protections under federal antikickback law.

“At a high level, I think that is likely to result in higher Part D premiums,” Piper tells AIS Health.

Advocates, Brokers, MAOs Promote Enrollees’ ‘Second Chance’

January 21, 2019

From brokers and insurers to medical societies and patient advocacy groups, everyone with an interest in Medicare this month appeared to begin promoting the newly reinstated Open Enrollment Period (OEP), which allows Medicare enrollees who selected a Medicare Advantage plan during the recent Annual Election Period (AEP) to make one change.

The 2019 AEP ran from Oct. 15 through Dec. 7, and while final enrollment results won’t be available until February, MA enrollment as of the Jan. 1, 2019, payment date was nearly 22.4 million, up 6.8% from 20.9 million a year earlier, according to new CMS data. The OEP, which last occurred in 2010 and was eliminated with the Affordable Care Act, began on Jan. 1 and will run through March 31. Various stakeholders are making an educational push to ensure that seniors are adequately informed of their options.

By Lauren Flynn Kelly

From brokers and insurers to medical societies and patient advocacy groups, everyone with an interest in Medicare this month appeared to begin promoting the newly reinstated Open Enrollment Period (OEP), which allows Medicare enrollees who selected a Medicare Advantage plan during the recent Annual Election Period (AEP) to make one change.

The 2019 AEP ran from Oct. 15 through Dec. 7, and while final enrollment results won’t be available until February, MA enrollment as of the Jan. 1, 2019, payment date was nearly 22.4 million, up 6.8% from 20.9 million a year earlier, according to new CMS data. The OEP, which last occurred in 2010 and was eliminated with the Affordable Care Act, began on Jan. 1 and will run through March 31. Various stakeholders are making an educational push to ensure that seniors are adequately informed of their options.

The National Council on Aging has been using Twitter to advise seniors of their “second chance” to change MA plans. And the Center for Medicare Advocacy has been informing seniors of this opportunity while posting charts aimed at clearly outlining the differences between Original Medicare and MA.

Meanwhile, CMS made clear in the updated Medicare Communications and Marketing Guidelines that plans may not knowingly target beneficiaries because they made a choice during the AEP. As a result, plans have focused their OEP efforts on education by adding OEP facts and information to their websites, posting blogs and articles on their Facebook pages and in newsfeeds, and sponsoring TV ads, observes Renee Mezzanotte with DMW Direct.

“One of the ways we monitor industry activity and spend is through Kantar Media,” Mezzanotte tells AIS Health. “Medicare TV activity just for the first week is up over 17%. We anticipate this will increase as the quarter progresses.”

Deft Research’s 2018 Medicare Member Experience study showed that more than 25% of Medicare beneficiaries are aware of the OEP. Michael Blix, research manager with Deft, says that the same study observed the kinds of member experiences people have early in the plan year that might cause them to be dissatisfied and take advantage of the OEP’s return. Those included members being billed more than they were expecting for a medical service and attempting to obtain a drug they used to fill that is no longer covered.