Radar on Medicare Advantage

Medicare consumers are facing an overwhelming variety of resources and plan choices and are showing signs of increased movement during the Open Enrollment Period (OEP). As a result, effective member engagement during the OEP and throughout the year is becoming increasingly important and can be achieved through using data to segment membership and deliver targeted, personalized messaging to ensure that a member is in the right plan from the start, industry experts advised during the 13th Annual Medicare Market Innovations Forum, hosted by Strategic Solutions Network, LLC (SSN).

After the Medicare Annual Election Period (AEP) that typically runs from Oct. 15 through Dec. 7, the three-month Medicare OEP starts on Jan. 1 and allows beneficiaries who selected a Medicare Advantage plan to make a onetime coverage change. This year was the fourth OEP since it was reinstated by the Trump administration after a hiatus, and seniors’ utilization of the renewed opportunity is growing.

A pilot with Drips’ trademarked “conversational texting” platform has helped WellCare significantly lower the percentage of Prescription Drug Plan policies that were being terminated due to nonpayment, according to a case study presented at the 13th Annual Medicare Market Innovations Forum, held May 11 and 12 in Phoenix.

Since WellCare was acquired by Centene Corp. in January 2020, the PDP team has been focused on “optimizing operational execution” and ensuring a positive member experience, said WellCare Senior Director of Prescription Drug Plans Talia Duany, who presented the case study with Drips. “When you’ve got 4.1 million members in an industry that’s shrinking — this year we saw the biggest [decline] in available PDP options, everyone’s moving into [Medicare Advantage] — having a robust member retention strategy” is critical.

Just a month shy of the bid deadline for the 2023 plan year, CMS on April 29 finalized most provisions of a sweeping Medicare Advantage and Part D rule that was proposed in January. Those provisions included restoring detailed medical loss ratio (MLR) reporting requirements, requiring MA Special Needs Plans to incorporate certain questions on social risk factors into health risk assessments, and finalizing a pathway to allow for star ratings to reflect a Dual Eligible SNP’s local performance. But one Part D provision regarding pharmacy direct and indirect remuneration (DIR) was notably delayed, allowing plans, pharmacies and pharmacy benefit managers time to renegotiate pharmacy pacts. 

“Generally speaking, the rule wasn’t surprising. CMS largely did what they proposed. I think the major concession that plans and PBMs were concerned about was the start date of the pharmacy DIR change, and they had that addressed. But by and large this rule was consistent with CMS’s goals of raising the bar for what it means to be a SNP and for reducing costs at point of sale for seniors” starting in 2024, says Tom Kornfield, senior consultant with Avalere.