Radar on Medicare Advantage

Long before the COVID-19 pandemic broke out, Medicaid managed care organizations were working with limited revenue streams and navigating across various waivers to address social determinants of health (SDOH). But the pandemic created a new hurdle for low-income enrollees struggling to access basic needs like food and transportation, underscoring the fragmented system in which communities and states currently function, according to panelists at the 12th Annual Medicaid Innovations Forum, hosted virtually from Feb. 1 to 4 by Strategic Solutions Network.

While the previous administration issued a “roadmap” for state health officials highlighting the various demonstration opportunities they have to address different SDOH categories, “there’s a lot more this new administration could do to accelerate progress on [SDOH] and to advance health equity,” starting with infrastructure, suggested Eric Beane, vice president of regulatory and government affairs with Unite Us, speaking during a Feb. 2 panel. “Right now, federal government programs are incredibly siloed. You have individual programs that look at one need of an individual — they don’t look at a whole person’s need, much less the needs of that family or that community — and it’s challenging to communicate…and collaborate across systems.”

As supply and scheduling issues have created slowdowns in COVID-19 vaccinations across the country, Medicare Advantage insurers are naturally concerned about their vulnerable senior members and are taking part in numerous partnerships to reach members and the broader community. But a new survey from SCAN Health Plan suggested another cause for concern: the hesitancy of senior caregivers to receive and/or take their seniors get a vaccine, which was especially evident in communities of color.

In a survey of 1,000 individuals who provide care for a family member older than 65, the Long Beach, Calif.-based MA insurer found that 71% have safety doubts about the COVID-19 vaccines that have been granted Emergency Use Authorization. Moreover, 31% of family caregivers who live in rural communities said they won’t take their older adult for the COVID-19 vaccine — nearly double the refusal rate of urban and suburban caregivers (16%).

From lowering cost sharing on select services to participating in the new Part D insulin model, Medicare Advantage insurers are incorporating new benefit flexibilities into their overall management of diabetes, which impacts one in every three Medicare beneficiaries.

Diabetes accounts for more than $300 billion in U.S. health care spending, including $17 billion spent on insulin in the Part D program. It also ranks as the most common condition served by specialized benefits in MA. According to a recent Faegre Drinker analysis, 23.7% of plans offering condition-specific benefits this year are targeting diabetes. The most popular benefits include reduced cost sharing on podiatry, physician specialist and primary care physician services, and additional supplemental benefits related to podiatry, meals and worldwide urgent coverage (see chart, p. 3).

An earlier version of this story incorrectly said Alignment Healthcare, Inc. launched its initial public offering on March 18; it only established the pricing range and had not begun trading that day.

Orange, Calif.-based Alignment Healthcare, Inc. will soon become the third startup insurer in recent months to go public. Banking on the strong value proposition of Medicare Advantage, Alignment said it already has a “national expansion strategy” that it will put into action next year, but some experts question whether the measured growth the insurer has achieved primarily in California can be duplicated in other markets. The initial public offering is expected to be priced between $17 and $19 per share, according to a March 18 press release announcing the impending launch.

✦ Federal Medicaid officials this week issued letters to Arkansas and New Hampshire informing them of the Biden administration’s formal revocation of their “community engagement” waivers. The Supreme Court on March 29 was planning to hear oral arguments related to the Trump administration’s approval of Medicaid work requirements in both states, but earlier this month removed the hearing from its docket, suggesting that previous rulings striking down work requirements could stand. View the Arkansas letter at https://bit.ly/30XShsh.

✦ The Biden administration has canceled two changes to the Part D Payment Modernization Model for 2022. One would have extended new formulary flexibilities to participating Part D plans, including in the so-called protected drug classes, in 2022. The other would have removed downside risk from the model. View a notice on the model changes at https://bit.ly/3c35Mxj.