Radar on Medicare Advantage

Given the likelihood of continued social distancing as a result of the COVID-19 pandemic, health plans and brokers selling Medicare Advantage plans this fall will rely heavily on call center and online enrollment, tele-sales, and virtual meetings and seminars, experts say. And while the so-called “kitchen table” approach may be out of the question, infusing a personal touch and delivering a positive member experience via remote sales will be critical to acquiring membership.

“There are lot of brokers who are not used to doing this [virtually]…and would rather put a shield in front of their desk and give customers face masks.…Some agents aren’t going to change and you’re not going to change them, but an increasing number of agents, especially those with tele-sales experience…are using technology successfully,” Dwane McFerrin, vice president of Medicare Solutions with Senior Market Sales, Inc. (SMS), said during a recent webinar hosted by Gorman Health Group. SMS, which supports more than 60,000 independent sales agents focused on the senior market, said the firm saw attendance double in March and April for webinars on conducting business virtually.

After providing a break to Medicare Advantage and Part D plans dealing with the COVID-19 pandemic by suspending audit and quality reporting activities, CMS appears to be hitting the restart button on 2020 program audits and risk adjustment data validation (RADV) audits. But with only five full months left in the calendar year, health plans and compliance experts are wondering how thoroughly CMS will conduct the annual program audit process, which focuses on a subset of MAOs that varies in size depending on the year.

Nevertheless, experts say clients should have been preparing for 2020 audits based on the draft protocols CMS released prior to the pandemic and just finalized with a few tweaks. At the same time, they must consider proposed changes for 2021 that were recently posted with a comment period.

✦ Centene Corp. said June 30 that its Illinois subsidiary, Meridian Health Plan of Illinois, Inc., agreed to acquire the membership of Next Level Health Partners, Inc. The deal calls for Meridian to transfer its 54,000 Cook County, Ill., Medicaid members who receive benefits from the Illinois Department of Healthcare and Family Services’ HealthChoice Illinois Program. NextLevel had said in June that it would close following the April collapse of a proposed deal for Molina Healthcare, Inc. to buy the plan for $50 million (RMA 4/16/20, p. 8). Centene said it provided the initial capital that NextLevel needed to obtain its HMO license at the end of 2017 and has provided operational support since then. The deal is expected to close in July 2020. Visit https://prn.to/3dLUjQh.

✦ Recent surveys report conflicting information about Medicare Advantage consumers’ level of satisfaction with how their insurer is communicating during the COVID-19 pandemic. Shortly after a Deft Research study showed that only 24% of MA customers reported that they are aware of their plan’s COVID-19 response (RMA 6/18/20, p. 5), a J.D. Power study posted June 18 gave MA insurers poor marks on communicating with members. Meanwhile, a Morning Consult survey of 1,020 seniors conducted on behalf of the Better Medicare Alliance (BMA) found that 49% of respondents were very satisfied with how their MA plan informed beneficiaries about their response to the coronavirus, 40% were somewhat satisfied and 9% were somewhat unsatisfied. Visit https://bit.ly/2YfTPgJ and https://bit.ly/3hI8BEt.

As Medicare Advantage and other insurers report increasing use of telehealth during the COVID-19 pandemic and consider the larger role that virtual visits could play on a more permanent basis, CMS recently finalized a set of policies for 2021 giving insurers more flexibility to design their provider networks, including supplementing them with telehealth. But one expert says it’s too soon to say how much telehealth will be utilized in the long term and that more information is needed to determine whether a reduction in network adequacy standards should apply more broadly in MA.

CMS Lowers T&D Percentage

Under current policy, MA plans must contract with a minimum number of in-person provider and facility types that are within a maximum time and distance from a beneficiary. In addition to codifying the list of provider/facility types subject to those standards, the final rule (85 Fed. Reg. 33796, June 2, 2020) firmed up a proposal to lower the required percentage of beneficiaries who must reside within the maximum time and distance (T&D) standards in non-urban counties from 90% to 85% (RMA 6/4/20, p. 6). At the same time, CMS said it will grant plans a 10% credit toward the percentage of beneficiaries living within published T&D standards when contracting with telehealth providers of a dozen specialty types, including cardiology, dermatology, ophthalmology and psychiatry.

Providing updated guidance three months into the COVID-19 pandemic, managed Medicaid leader Centene Corp. last month raised its full year adjusted earnings per share outlook by 20 cents at the midpoint to an EPS range of $4.76 to $4.96. And while only an estimated 7% of 2019 revenue came from Medicare, executives recently emphasized Centene’s expectation that the Medicare market will be a growth driver going forward.

During its 2020 Virtual Investor Day on June 12, the insurer said it expects total revenues for full year 2020 to be between $109.5 billion and $111.9 billion. That’s a reduction of $500 million due to the delayed start date of its North Carolina Medicaid pact. Centene also said it expects overall membership growth to peak in the third quarter with an increase of approximately 1.9 million members, driven in large part by Medicaid. Centene as of March 31 served 23.8 million enrollees, including 11.8 million Medicaid lives. The acquisition of WellCare Health Plans, Inc., which closed in January, roughly doubled Centene’s Medicare Advantage membership to 976,700 lives. WellCare also had 4.4 million stand-alone Prescription Drug Plan members as of March 31.