Radar on Medicare Advantage

Medicare Advantage organizations interested in testing the inclusion of a hospice benefit through their plans in 2021 will be tasked with ensuring timely and appropriate access to high-quality hospice care while also making sure that eligible beneficiaries receive palliative care. CMS unveiled the opportunity in January 2019, and in a request for applications (RFA) posted Dec. 19, it provided long-awaited details for how it expects MAOs and hospice providers to create a seamless care continuum for MA beneficiaries who elect hospice — a plan that one leading hospice organization found lacking.

The demonstration is part of the MA Value-Based Insurance Design (VBID) model that began in 2017 and now caters to roughly 1.2 million beneficiaries enrolled in plan benefit packages offered by 14 participating MAOs, CMS said in a press release accompanying the RFA. By reducing fragmentation and creating more financial responsibility for MAOs, the hospice component of the model will allow MAOs to better coordinate palliative and hospice care for beneficiaries, CMS said.

For Medicare Advantage Special Needs Plans (SNPs) and other insurers serving individuals who are eligible for both Medicare and Medicaid, 2020 “will be the year of building momentum for integration of dual eligibles,” declares Cheryl Phillips, M.D., president and CEO of the SNP Alliance.

More than 3.1 million MA beneficiaries are currently enrolled in a SNP, including nearly 2.7 million individuals served by a Dual Eligible SNP (D-SNP). The plans, which can also take the form of Chronic Condition SNPs (C-SNPs) or Institutional SNPs (I-SNPs), were authorized under the Medicare Modernization Act of 2003 and went through a series of brief reauthorizations until the Bipartisan Budget Act of 2018 granted them permanent authorization. That legislation called for D-SNPs and states to better unify appeals and grievances processes across the Medicare and Medicaid programs and set new minimum standards for D-SNPs integrating Medicaid benefits.

With early signs of strong enrollment growth in 2020 and a healthy pay outlook in 2021 given the elimination of the Affordable Care Act health insurer fee and an anticipated rate increase, the sun continues to shine on Medicare Advantage. Even as momentum around Medicare for All and other universal health care proposals continues to build, industry experts say MA remains the safest game in town and will likely serve as a road map for any such health care reform. At the same time, insurers will continue to face program hurdles such as evolving audit practices, and they may want to consider strategic investments to boost their integrated care capabilities and remain competitive.

In our annual roundup of forward-looking remarks, industry experts share their predictions on the challenges, policy developments and trends that are likely to impact the MA market in 2020 and beyond.