Radar on Medicare Advantage

The Medicare Payment Advisory Commission (MedPAC) in its June report to Congress unveiled new details about its proposal to revamp the current system of awarding highly rated Medicare Advantage plans with quality bonuses. MedPAC presented two possible ways the proposed MA value incentive program (MA-VIP) introduced in last year’s report would reward — and penalize — plans based on a stripped-down set of population-based performance measures.

Similar to the way Medicare-Medicaid Plans are paid in the CMS Financial Alignment Initiative, the MA-VIP could involve a payment withhold of 2% of plans’ total payments to fund a shared pool. Payments would be reduced for the year in which plan performance is assessed, and the withheld funding would be redistributed based on quality scores and sent to plans in a lump sum. Plans that received less than the original percent withheld would essentially be paying a penalty, while those receiving payments that are larger would be rewarded, MedPAC explained.

Although major Medicare Advantage insurers grabbed the bulk of enrollees during the recent Medicare Open Enrollment Period, several smaller plans made significant headway in the OEP that reflected their Annual Election Period (AEP) performance, according to a recent AIS Health analysis (RMA 5/21/20, p. 5). One such plan was Orange, Calif.-based Alignment Healthcare, which gained about 14,000 members in California over both periods for nearly 30% growth and now serves 63,360 MA enrollees.

While that was due in large part to geographic expansion and new co-branded offerings with Sutter Health, an “on-demand personalized concierge” feature and its data-driven approach to closing care gaps have also allowed Alignment to differentiate itself in the market, a company executive tells AIS Health.

As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard look at health and access inequities. Meanwhile, a new report from CMS indicates that racial disparities are widening in Medicare Advantage, and experts suggest one way for plans to address those would to be to make immediate investments in their provider networks.

“You see some very consistent themes in that report around inadequate provider networks in vulnerable minority communities. And those findings are only going to worsen in the middle of this pandemic when you consider that providers as small businesses are extremely vulnerable because of fluctuations in their revenues,” says John Gorman, chairman and CEO of Nightingale Partners LLC, the first Opportunity Zone fund dedicated to making major investments in social determinants of health with MA and Medicaid plans.

✦ America’s Health Insurance Plans and other leading health care organizations are urging Congress to further increase funding for Medicaid. In a June 2 letter to House and Senate leaders, the groups praised Congress for enacting a temporary 6.2% increase to states’ Federal Medical Assistance Percentage (FMAP) as part of the Families First Coronavirus Response Act but pleaded with them to take additional action as millions of Americans apply for unemployment and states consider budget cuts. The House in late May passed the Heroes Act, a $3 trillion legislative package that includes an additional temporary increase in the FMAP and enhanced funding for home- and community-based services (RMA 5/21/20, p. 1). Senate Republicans have already criticized the legislation and are reportedly under pressure to deliver their own COVID-19 response package now that the Senate is back in session after a 10-day recess. Visit https://bit.ly/3gMRAJ0.

✦ The Indiana Dept. of Administration on May 26 unveiled managed care awards to serve some 90,000 Aged, Blind and Disabled enrollees in the state’s Hoosier Care Connect program starting April 1, 2021. The state selected three managed care organizations to begin contract negotiations; these included incumbents Anthem, Inc. and Managed Health Services and new entrant UnitedHealthcare Community Plan. The new four-year pacts represent annual revenue of approximately $533 million for each winner. Visit https://bit.ly/3chHpbW to view the Indiana contract awards.

When Banner Health Network (BHN) was vying for a spot in Arizona’s revamped $14 billion managed Medicaid program, the integrated health care system knew it needed something innovative to meet the state’s expectations for merging physical and behavioral health services. In late 2017, it synced up with emerging mobile technology provider Pyx Health, which focuses on social isolation and loneliness, and has found the tools provided by Pyx to be useful in triggering real-time interventions and providing the outcomes the state was seeking.

The Arizona Health Care Cost Containment System (AHCCCS) in 2017 issued a request for proposals from managed care organizations that would coordinate the physical and behavioral health care needs of 1.5 million Medicaid members. BHN was chosen as one of seven MCOs to integrate services for the new Complete Care program, which replaced the state’s Acute Care managed Medicaid program on Oct. 1, 2018. BHN, which is a clinically integrated network and accountable care organization that merged with University Health Plans in 2015, has a separate contract to serve the state’s long-term care program and operates a Dual Eligible Special Needs Plan (D-SNP).