Radar on Medicare Advantage

Starting with the 2027 Star Ratings, CMS will begin rewarding Medicare Advantage plans for their efforts to assess social risk factors and address disparities in certain quality measures with the new Health Equity Index (HEI). Not all plans will qualify and only a third of top-performing plans will be rewarded, but the time is now for plans to look at how they are doing on the claims-based measures that will be impacted and how they are performing for members with one of the qualifying factors (i.e., eligible for Medicare and Medicaid, disability and/or the Part D low-income subsidy).

During a recent panel moderated by AIS Health, a division of MMIT, speakers at the 7th Annual Medicare Advantage Leadership Innovations forum discussed best practices for assessing members’ social needs and how plans can use data to address them and move the needle forward on health equity. 

As the second batch of publicly traded insurers posted fourth-quarter and full-year 2023 financial results, continued utilization pressures in Medicare Advantage remained a prominent theme during earnings calls held in the first two weeks of February. Such pressures prompted Humana Inc. to slash its outlook for 2024, but this month only CVS Health Corp.’s Aetna lowered its adjusted earnings per share (EPS) guidance, while The Cigna Group — which is planning to sell its relatively small MA business — raised its outlook.

CVS Health Corp. on Feb. 7 reported fourth-quarter adjusted EPS of $2.12 and full-year adjusted EPS of $8.74. Consolidated revenue grew 11.9% year over year to $93.8 billion, while revenue for the Health Care Benefits segment, which includes Aetna’s MA business, increased 16% to nearly $27 billion. CVS Health said it added 1.3 million members in 2023, which reflected growth across multiple product lines.

As Medicare members become increasingly comfortable with using technology to manage their care at home, tech-enabled vendors continue to flood the Medicare Advantage space to offer solutions aimed at everything from fall prevention and functional mobility to specific conditions like Alzheimer’s and cardiovascular disease. Speaking at the 7th Annual Medicare Advantage Leadership Innovations forum, held Jan. 30 and 31 in Scottsdale, Arizona, vendors and MA plans shared the nuanced and personalized approaches they’ve taken to engage seniors with digital solutions.

“I think one of the challenges with [seniors and] technology is trying to really navigate tension between high tech and high touch. And I think that’s one of the things that you need to really figure out with your members early on: What are their preferences and needs? What resources do they have available?” said Joel Salinas, M.D., chief medical officer with Isaac Health, who spoke on a member engagement panel moderated by AIS Health, a division of MMIT.

“Subpar” Medicare Advantage provider networks are costing the Medicare Advantage industry approximately $23 billion a year, according to Quest Analytics. That was just one of the staggering statistics shared at the 7th Annual Medicare Advantage Leadership Innovations forum, held Jan. 30 and 31 in Scottsdale, Arizona. As speakers discussed common industry themes of health equity, member engagement and quality improvement, the following percentages and dollar amounts helped to illustrate the impact of addressing (or failing to address) these and other health care issues. Click the quote icons below to see what presenters had to say about each one.