Radar on Medicare Advantage

As CMS takes multiple steps to steer managed care organizations and states toward advancing health equity across government programs, the agency’s Office of Minority Health recently put out its annual report illustrating persistent disparities in Medicare Advantage. Released for National Minority Health Month and produced in collaboration with The RAND Corp., the 2023 Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex report showed some modest improvements on clinical care measures for a few groups, but a substantial proportion of clinical care scores continued to fall below the national average for American Indian/Alaska Native (AI/AN), Black and Hispanic MA enrollees.

Compared with the traditional, fee-for-service Medicare program, the MA program serves a larger proportion of minority enrollees. The report compared care for six groups across 44 measures: (1) seven patient experience measures based on responses to the 2022 Consumer Assessment of Healthcare Providers and Systems (CAHPS), which was conducted between March and May of last year and asked respondents about care received in the six months prior to the survey, and (2) 37 clinical care measures based on the Healthcare Effectiveness Data and Information Set (HEDIS) that is collected from medical records and administrative data and reflects care received in 2021.

As the industry prepares for a comprehensive overhaul of the model used to determine Medicare Advantage insurers’ risk-adjusted pay, the top three MA organizations signaled during recent earnings calls that they are well positioned for the changes.

Reporting first-quarter 2023 financial results on May 3, CVS Health Corp. beat Wall Street expectations of $2.09 per share with adjusted earnings per share (EPS) of $2.20, largely driven by better-than-expected membership in the health care benefits segment despite a year-over-year increase in medical loss ratio. Total revenues increased 11% from the first quarter of 2022 to reach $85.2 billion, fueled by growth across all segments, while the health care benefits segment (Aetna) generated revenues of $25.9 billion, up from $23.1 billion a year ago. Medical membership grew sequentially by 1.1 million members to a total of 25.5 million lives as of March 31, reflecting increases across all product lines including growth of 900,000 in the Affordable Care Act exchange business.

In the first year of the COVID-19 pandemic, when many people were having trouble accessing basic personal protective equipment, Highmark Blue Cross Blue Shield began sending out care kits including PPE and other items to support seniors at home. The response from Medicare Advantage members was so positive that what started out as a feel-good gesture has become a full-blown supplemental benefit, and the insurer continues to refine the kits to meet members’ evolving needs and ensure continued satisfaction with the plan.   

Starting with plan year 2022, eligible Highmark members were given the option to receive one of 17 condition care kits. Commonly referred to as the “big blue box,” each kit is filled with a variety of items tailored to a specific condition, with a focus on member choice and high quality, speakers from Highmark and its strategic partner RR Donnelley explained during the 14th Annual Medicare Market Innovations Forum, held on March 28 and 29 in Orlando.