Radar on Medicare Advantage

  • Pricey Drugs and Discounts Cause Part D Costs to Shift to Medicare

    In addition to unveiling details on its proposal to overhaul the Medicare Advantage quality bonus program (RMA 6/18/20, p. 3), the Medicare Payment Advisory Commission (MedPAC) in its June report to Congress recommended major reforms to the Part D program that would shift more drug costs from Medicare to payers and drug manufacturers (see pie charts below). Citing the use of high cost drugs pushing beneficiaries into the catastrophic phase of the benefit as leading to greater reinsurance spending, MedPAC once again recommended changing Medicare’s reinsurance subsidy from 80% to 20%. MedPAC would also do away with the coverage gap discount program and require drugmakers to provide discounts of at least 30% in the catastrophic phase.

    MedPAC also suggested that under the current Part D structure, how much manufacturers will have to pay in coverage gap discounts may factor into their decisions about price increases or launch prices, and pointed out that coverage gap discounts for relatively low priced drugs make up a larger share of drugmakers’ revenues. “For drugs and biologics with prices near or above the catastrophic threshold, manufacturer discounts in the coverage gap are small compared with their revenue from Part D prescriptions,” the commission wrote. The table below outlines this phenomenon using 2018 data.

  • News Briefs

     In addition to offering premium discounts and/or rebates to commercial enrollees as a result of higher earnings during the COVID-19 pandemic, several Blues plans at press time unveiled premium-relief actions for Medicare Advantage enrollees. BlueCross BlueShield of Massachusetts, for one, said it would give MA members a one-month “premium holiday” before the end of 2020. As part of a plan to provide $70 million in premium rebates and discounts, Blue Cross and Blue Shield of Minnesota said it would extend about $38 million in premium relief to Medicare members, people who purchase individual health plans and certain business customers through one-time credits of 10% to 25%, according to the Star Tribune. And Blue Cross Blue Shield of Michigan last month issued about $15 million in refunds to Medicare Supplement and individual MA customers in the form of premium credits for March and April that were applied to their July premium bill, according to America’s Health Insurance Plans (AHIP). Visit AHIP’s ongoing summary page of insurers’ COVID-19 response actions at https://bit.ly/3iXsLdL.

     Norfolk, Va.-based Sentara Healthcare and Greensboro, N.C.-based Cone Health have signed a letter of intent to combine their regional, community-based health systems. Sentara, an integrated, not-for-profit system comprising 12 hospitals in Virginia and northeastern North Carolina, operates the Optima Health and Virginia Premier health plans, which have about 700,000 Medicaid members combined. Cone Health, a not-for-profit integrated health care network consisting of five hospitals in North Carolina, has a Medicare Advantage plan, HealthTeam Advantage, that serves 15,000 members. The combination is anticipated to close in mid-2021. Visit https://bit.ly/3iOEYBe.

  • Sutter Health Created ‘Aligned Broker Strategy’ to Boost MA Enrollment

    Nonprofit health system Sutter Health during the last Medicare Annual Election Period launched several Medicare Advantage products with Orange, Calif.-based MA startup Alignment Healthcare, which as of June had enrolled about 7,000 members (RMA 6/18/20, p. 1). That partnership is just one part of Sutter’s overall strategy to grow its share of MA members, and the organization has spent the last four years cultivating an omnichannel approach that includes online aggregator eHealth, according to Alan Jones, executive director of Medicare sustainability for Sutter.

    Speaking at a webinar hosted by World Congress, Jones explained that the health system consists of 24 hospitals and 5,500 providers in Northern California, a “polycentric economic region” with hotspots of economic activity around San Francisco that shape how Sutter is organized as a system. Sutter sees anywhere from 500,000 to 600,000 Medicare beneficiaries in a year (out of a total 2 million in the region) and has an “imperative mission to continue to support that population well into the future,” said Jones.

  • MCOs Posting 2Q Earnings Saw Satisfactory Gains in MA

    While second-quarter 2020 earnings calls centered largely on uncertainty related to the COVID-19 pandemic, insurers with a large Medicare Advantage presence expressed satisfaction in membership growth so far this year and confidence in their positioning for the 2021 Annual Election Period (AEP).

    Reporting second quarter earnings on Aug. 5, Humana Inc. exceeded analysts’ expectations with adjusted earnings per share (EPS) of $12.56 and other metrics that it attributed to customers delaying care due to stay-at-home orders and pandemic-related concerns. That deferral of care was partially offset by costs related to COVID-19 testing and treatment in the quarter as well as the company’s pandemic relief efforts, explained Chief Financial Officer Brian Kane during an Aug. 5 call to discuss recent quarterly earnings.

  • Heal’s Home-Based Care Model Aims to Reduce Senior ER Use

    As visits to hospitals and outpatient clinics have become sources of anxiety for patients worried about exposure to the novel coronavirus, plans and providers alike have begun to make major investments in home care. One such plan is Humana Inc., which announced a $100 million investment in home primary care startup Heal Inc. last month. Heal CEO Nick Desai tells AIS Health his company will aid Humana’s long-term strategy to reduce the cost of care and improve quality.

    Heal’s model places patients with a consistent primary care physician who makes house calls. The doctors are dispatched and routed using an app and driven to visits with a medical assistant, and they input notes and update care plans into an electronic health record between visits. According to Desai, the company’s physicians typically see 10 or fewer patients per day and spend 30 minutes to an hour with each.

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