Radar on Medicare Advantage
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PACE Market Sees Steady Growth, Diverse Pool of Providers
Enrollment in Programs of All-Inclusive Care for the Elderly (PACE) topped 51,000 people in 2021, according to AIS’s Directory of Health Plans, representing a small but impactful segment of the Medicare market that’s seen consistent annual growth. Notably, no large national entities have a significant PACE presence, leaving regional actors to control the market. The largest PACE organization, InnovAge, enrolls just 12% of all lives, and the average PACE organization enrolls about 430 participants, per AIS data. There will be 14 new PACE plan IDs on the market in 2022, according to research from Clear View Solutions, LLC, up from 12 in 2021. And just two IDs have exited the market for 2022, Clear View found. See an overview of the current PACE market below.
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Rewards and Incentives Rule Has Compliance, Stars Implications
Although it may have gone largely unnoticed by Medicare Advantage plans this year, a clarification regarding rewards and incentives (R&I) programs embedded in an 894-page final rule issued in January 2021 could have significant implications for plans’ star ratings strategy in addition to posing compliance risks and added costs in 2022. Industry experts say now is the time for plans to get compliant with the provision, which goes into effect on Jan. 1, 2022, and to begin rethinking their R&I programs to incentivize healthy behavior across the broader MA population and not just those members who are falling behind in their star measures.
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Stakeholders Consider Impact of BBBA Drug Pricing Reforms on Formularies, Innovation
The Build Back Better Act (BBBA), which passed the House on Nov. 19 but at press time was looking less and less likely to meet Democrats’ self-imposed Christmas deadline, contains multiple drug pricing reforms that could lead to more than $300 billion in savings over the next decade, according to estimates from the Congressional Budget Office (CBO). These provisions include an overhaul of the Medicare D benefit, which a recent Avalere Health analysis suggests could lead to greater increases in mandatory manufacturer discounts on brand drugs within the benefit’s six “protected classes” compared with brand Part D drugs overall.
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Ahead of 2023 Rate Setting, BMA Issues End-of-Year Wish List
As CMS gets ready to set Medicare Advantage rates for the 2023 calendar year, the Better Medicare Alliance in a Dec. 6 letter urged Administrator Chiquita Brooks-LaSure to take several actions to address social determinants of health (SDOH) and close the gap on longstanding racial disparities. The research and advocacy group supports more than 170 ally organizations that include several major MA insurers. Among its recommendations, BMA asked that CMS:
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News Briefs: New Research Shows Rise in Telehealth Use Among Medicare Enrollees| Dec. 16, 2021
New statistics showing a rise in telehealth usage among Medicare beneficiaries during the pandemic make a strong case for permanently expanding telehealth coverage for Medicare patients. A new report from the HHS Assistant Secretary for Planning and Evaluation (ASPE) found that the number of FFS beneficiary telehealth visits rose from approximately 840,000 in 2019 to nearly 52.7 million in 2020, with the largest increase seen in behavioral health specialist visits. Black and rural beneficiaries demonstrated lower use of telehealth compared with white and urban beneficiaries, respectively. The report did not include results for Medicare Advantage members, since plans had discretion to offer telehealth prior to the pandemic, noted ASPE. Meanwhile, a new Medicare Telemedicine Data Snapshot from CMS showed that the number of Medicare beneficiaries (including MA enrollees) using telemedicine services between March 1, 2020, and Feb. 28, 2021, increased over 30 times the number of users from the prior year (March 2019 to February 2020). Dual eligibles had higher use of telehealth than those with just Medicare. “These latest numbers prove that when given the resources and opportunity to use telemedicine, many of these patients will opt to use the technology,” wrote Connected Nation, which seeks to fill broadband and digital technology gaps through partnerships across all sectors. “We would argue that among the critical needs is to expand not only access to broadband but also working to ensure it is affordable and that others understand both how to access the technology and how it can benefit them.”
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