Radar on Medicare Advantage
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News Briefs: New CMS Report Finds Non-White Medicare Advantage Enrollees Continue to Receive Worse Care
A new report looking at disparities in care for Medicare Advantage beneficiaries by race, ethnicity and sex found that non-white MA enrollees generally received worse care in 2020 than their white counterparts. Racial and ethnic differences were more glaring for clinical care measures than for patient experience measures, with scores for Black MA enrollees falling below the national average for 14 out of 36 clinical care measures, according to the April report, which was prepared by The RAND Corp. for the CMS Office of Minority Health. Researchers relied on Consumer Assessment of Healthcare Providers and Systems (CAHPS) data collected from March to May 2021 and the Healthcare Effectiveness Data and Information Set reflecting care received from January to December 2020. White enrollees reported care that was in line with the national average on all patient experience measures from the CAHPS survey, while their scores were similar to the national average on 31 clinical care measures and above average on five measures. Scores for American Indian and Alaska Native MA enrollees were also below the national average on 14 clinical care measures, and scores for Hispanic MA beneficiaries were worse than average on 11 such measures.
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Enforcement Actions Show Mounting CMPs from Financial Audits (with table: CMP Amounts Imposed on Medicare Advantage Insurers From February to April 2022)
Between February and April of this year, CMS imposed a total of nearly $1 million in civil monetary penalties (CMPs) on Medicare Advantage and Part D organizations for program violations uncovered during routine audits, including so-called “one-third financial audits.” While CMS has yet to release its annual report that provides a fuller picture of plan noncompliance, the latest round of CMP notices offers some important lessons for sponsors and flags a few potential areas of risk that they should be monitoring in their own operations, according to compliance experts.
Of the 15 CMP notices recently posted to the CMS Part C and Part D Enforcements Actions webpage, six resulted from 2021 program audits and eight were related to 2020 financial audits. Additionally, CMS imposed a fine on Anthem, Inc. for a Part D appeals violation stemming from a previously detected system migration issue that occurred in 2020.
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Despite Growth, Barriers Remain to Driving Benefit Innovation
Innovative, mostly non-medical supplemental benefits have seen tremendous growth in the few years the Medicare Advantage program has allowed them. But that growth is still from a base of zero, and industry experts suggest that numerous barriers are keeping adoption of these new supplemental benefits at a relatively slow pace.
Starting with plan year 2019, MA organizations began offering a wider range of benefits such as Adult Day Care and In-Home Support Services thanks to CMS’s reinterpretation of the definition of “primarily health-related supplemental benefits.” And with the passage of the CHRONIC Care Act of 2018, MA plans in 2020 began offering Special Supplemental Benefits for the Chronically Ill (SSBCI), a category of “non-primarily health related” items and services that can be made available to certain beneficiaries.
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Nearly One-Third of Medicare Advantage Members Receive Extra Supplemental Benefits as of 2022
More than 30% of Medicare Advantage members are currently enrolled in a plan that offers at least one type of newer supplemental benefit, according to an April report from ATI Advisory and the Long-Term Quality Alliance. Researchers studied the growth of both Special Supplemental Benefits for the Chronically Ill (SSBCI), established by the CHRONIC Care Act of 2018 and first made available to eligible beneficiaries in 2020, and Expanded Primarily Health-Related Benefits (EPHRB), which emerged in 2019 following CMS’s reinterpretation of the definition of “primarily health-related.” Both benefit types have grown significantly over the past two years, with nutritional benefits, transportation and in-home support services among the most popular offerings. Just one benefit type, adult day health services, saw a decline in uptake, which report authors attributed to lack of availability caused by the COVID-19 pandemic. See an overview of the findings in the table below.
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UnitedHealth Delivers Strong 1Q, Touts MA, Value-Based Growth
Despite variations in care utilization due to COVID-19 that drove up medical costs early in the quarter, UnitedHealth Group reported a strong start to 2022, with financial results exceeding analysts’ expectations driven by outperformance in both the UnitedHealthcare and Optum Health segments. As the company anticipates continued growth in value-based care initiatives and Medicare Advantage enrollment throughout the year, it raised its full-year adjusted earnings-per-share (EPS) outlook by 90 cents to a range of $21.20 to $21.70.
For the three months ending on March 31, the company recorded overall revenues of $80.1 billion, representing a year-over-year increase of 14.2% that reflected double-digit growth at both Optum and UnitedHealthcare. The UnitedHealthcare segment reported $62.6 billion in revenues, up 13.6% from $55.1 billion a year ago, and operating earnings of $3.8 billion, compared with $4.1 billion last year, reflecting the effects of “pandemic-disrupted care patterns,” the company explained in its earnings press release. Revenue for the Medicare & Retirement segment was $29.1 billion, up from nearly $25.5 billion in the first quarter of 2021.
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