Radar on Medicare Advantage

✦ Humana Inc. on Feb. 4 said it partnered with private equity firm Welsh, Carson, Anderson & Stowe (WCAS) to expand access to value-based care for Medicare patients. Through the new joint venture, the partners will develop and operate “senior-focused, payor-agnostic, primary care centers” that will be managed by Humana’s Partners in Primary Care subsidiary and operated under the PIPC brand. WCAS is making an initial commitment of $600 million to the joint venture, in which it will have majority ownership. (The firm owns a majority stake in MMIT, AIS Health’s parent company.) Visit https://huma.na/370wr7Y.

✦ By investing in nine weeks of intensive training for 75 community health workers (CHWs), Inland Empire Health Plan (IEHP) on Jan. 23 said it has launched the biggest community health workforce of its kind in the Inland Empire region of California. The newly trained CHWs will support comprehensive care management for IEHP members who have chronic conditions and are enrolled in the state’s Health Homes Program, which targets the highest risk 3% to 5% of Medi-Cal beneficiaries (RMA 9/20/18, p. 3). Visit www.iehp.org.

With supplemental benefits increasingly playing a role in shopping and switching behavior, Medicare Advantage carriers should be doing everything they can to highlight their supplemental offerings for existing and new customers during enrollment periods. And as product design gets underway for the 2021 plan year, MA organizations that want to stand out in their respective markets should survey members now on what inspired 2020 plan selections and use that data to make localized decisions, experts from Carrot Health and Deft Research advised during a recent webinar.

MA enrollees during the most recent Annual Election Period (AEP) had more plans than ever to choose from, with about 21 available plans for every 100,000 enrollees, compared with 15 plans two years ago, according to Carrot Health, a technology firm that uses predictive analytics to help clients deliver targeted strategies. At the same time, plan benefits are richer than ever, with supplemental benefits being offered by new plans at a higher rate than their competitors, said Spencer Pratt, vice president of product with Carrot, during the Jan. 29 webinar, “AEP Results: What’s Happening in 2020?”

Surveys have shown that cognitive decline is a chief concern among aging adults, yet brain health and “memory fitness” remain largely untapped areas as Medicare Advantage insurers experiment with new benefit design flexibility. But as a growing body of research builds a clinical case for so-called “brain training” programs, Posit Science is eager to get its own BrainHQ exercises in front of MA enrollees and says three insurers have incorporated them into supplemental benefits for 2020.

When advising MA organizations on newly expanded supplemental benefits, CMS in an April 2018 memo highlighted a “standalone memory fitness benefit” as one of nine potential services that could be offered starting in 2019 (RMA 5/17/18, p. 1). But a Milliman, Inc. analysis of the 2019 plan benefit package files did not identify any new standalone memory fitness benefits being offered that year. And in 2020 it continued to receive less attention than buzzworthy benefits such as nutrition or transportation or acupuncture (which was offered by 32 plan IDs in 2020, according to a CMS summary of supplemental benefits highlighted on the Medicare Plan Finder). Nevertheless, “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.

CMS on Feb. 5 released Part II of the Advance Notice proposing payment changes for Medicare Advantage and Part D plans for 2021, but at press time did not include the draft Call Letter. The agency also posted a proposed rule with changes to the MA and Part D programs for contract years 2021 and 2022.

Following up on Part I of the Advance Notice, which was released in January and included several expected changes to the risk adjustment model (RMA 1/16/20, p. 1), Part II called for roughly a 1% increase in MA payment rates. Although this estimate is lower than the 2.5% increase plans got in 2020, Citi Research securities analyst Ralph Giacobbe on Feb. 6 noted that it could change with the final rate notice in April. The notice did not, however, adjust rates for serving enrollees with end-stage renal disease, he pointed out.

After months of languishing at the Office of Management and Budget, CMS’s long-awaited state Medicaid director letter addressing so-called block grants appeared on Jan. 30. But the revised 56-page “Healthy Adult Opportunity” guidance made no mention of block grants — which Democrats have long argued are harmful and illegal if applied in entitlement programs — and instead presented states with two options for covering a subset of Medicaid enrollees via a fixed budget with additional program flexibilities. Safety net insurers and Medicaid advocates worry that if implemented, such options could restrict certain “able-bodied” adults from maintaining coverage, while analysts predict such coverage losses would be minimal.

CMS in June had submitted the guidance under the name “State Medicaid Director Letter: Medicaid Value and Accountability Demonstration Opportunity” but pulled that version in November and replaced it with a letter extending a new Section 1115 waiver opportunity to “provide cost-effective coverage using flexible benefit designs under either an aggregate or per-capita cap financing model for certain populations.”