Radar on Medicare Advantage

✦ CareFirst BlueCross BlueShield plans to acquire two Medicaid managed care organizations in the Baltimore and Washington, D.C., areas, respectively. CareFirst on Dec. 20 said it reached separate definitive agreements with Trusted Health Plan, a Medicaid MCO operating exclusively in Washington, D.C., and University of Maryland Health Partners, which serves 47,000 Medicaid enrollees in 20 Maryland counties and Baltimore. The latter is owned by the University of Maryland Medical System, which also offers a Medicare Advantage plan that was not part of the transaction. Trusted began operations in 2013 and covers more than 34,000 enrollees; the company sold its Michigan managed Medicaid business to Health Alliance Plan in June 2019 (RMA 6/20/19, p. 8). View the announcement at https://bit.ly/2uar20l.

✦ In its first partnership with a managed Medicaid plan, Fitbit this month kicked off a new wellness program with WellCare of Georgia Medicaid. Amy McDonough, senior vice president and general manager for Fitbit Health Solutions, in a LinkedIn blog post explained that approximately 4,000 WellCare members with type 2 diabetes will be eligible to receive a Fitbit Inspire device, along with educational materials and activity challenges through Fitbit’s platform. The aim of the new program is to help members adopt healthier behaviors to better manage their diabetes, she wrote. This builds on the company’s growing number of partnerships in the Medicare Advantage market. Fitbit said its devices will be included in MA plans offered this year by three insurers, including as an embedded benefit in 59 plans offered by UnitedHealthcare across 27 states. Visit https://bit.ly/2QG5XSZ.

The five insurers that were selected for new statewide contracts with Kentucky’s managed Medicaid program will have to rebid now that the state’s new Democratic governor, Andy Beshear, has nullified the awards made under Republican predecessor Matt Bevin.

The Kentucky Cabinet for Health and Family Services (CHFS) in late November selected Aetna (owned by CVS Health Corp.), Humana-CareSource, Molina Healthcare, Inc., UnitedHealthcare and WellCare Health Plans, Inc. to serve approximately 1.3 million Medicaid and CHIP enrollees starting on July 1, 2020. New entrants Molina and UnitedHealthcare would have replaced Anthem, Inc. and Passport Health Plan.

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.