Radar on Medicare Advantage

As the Iowa Dept. of Human Services considers making changes to its managed Medicaid program, IA Health Link, State Auditor Rob Sand last month released a damning report that says the state’s 2016 transition to managed Medicaid led to an 891% increase in “illegally denied services or care.” The report also details how two managed care organizations violated provisions of their contracts with the Dept. of Human Services, although DHS says the report is flawed. Since 2019, only two insurers have been serving the program, but DHS is considering adding up to two more.

Since Iowa transitioned the bulk of its fee-for-service Medicaid population to managed care under then-Gov. Terry Branstad (R), it’s been one drama after another — from providers not getting paid, to providers reportedly being allowed to keep overpayments, to MCOs incurring financial losses and dropping out — and Democrats want the whole thing scrapped. Sand, a Democratic former assistant attorney general, has been gunning for the program since his 2018 race for auditor and recently used a tour of the state to talk about some of the issues facing the program.

✦ CMS on Nov. 2 finalized changes intended to boost participation in the Medicare Diabetes Prevention Program (MDPP) expanded model. In the Calendar Year 2022 Physician Fee Schedule final rule, CMS finalized proposals to waive the Medicare enrollment fee for MDPP suppliers beyond the end of the public health emergency, shorten the program services period to one year by eliminating the second year of maintenance sessions, and redistribute all of the Ongoing Maintenance sessions phase performance payments to certain Core and Core Maintenance Session performance payments.

✦ The 2022 Medicare Advantage landscape is looking more robust than ever, with a record 3,834 MA plans available across the country, up 8% from 2021, according to a Kaiser Family Foundation (KFF) analysis. On average, beneficiaries will have 39 plans to choose from in their local market, compared with 33 plan options in 2021, KFF observed. However, because of consolidation in the stand-alone Prescription Drug Plan market, the typical Medicare beneficiary will have 23 PDP options next year, down from 30 in 2021, added KFF. Meanwhile, a separate analysis from Drug Channels found that 66% of MA-PD plans and 98% of stand-alone PDPs will have a preferred cost sharing network (i.e., preferred pharmacy network) in 2022. According to that analysis, 92% of the total 766 PDPs in 2022 are operated by one of eight major insurers, which all have preferred cost sharing networks.

As Medicare Advantage insurers promote an array of enhanced supplemental benefits for the 2022 plan year, grocery store allowances appear to be a staple among Dual Eligible Special Needs Plans. Here’s a sampling of what major D-SNP sponsors are marketing to eligible enrollees.

Many of Anthem, Inc.’s affiliated MA plans will give qualifying members access to the Healthy Groceries Card, either as an embedded benefit or as part of the Essential Extras/Everyday Extras (EE) package. When offered as part of the EE package, members can select the card among a list of other benefits and receive a monthly allowance loaded on the card each month, explains a company spokesperson. The grocery card feature is part of new co-branded offerings with Kroger Health, which will be available in four regions in 2022 and include D-SNPs. Eligible recipients in Kentucky will receive the richest grocery card allowance, with up to $100 per month available to purchase nutritious food and health and wellness items from Kroger Family Stores. In Georgia, Ohio and Virginia, the Anthem-Kroger plans have a $75 monthly allowance. Qualifying members in all four regions can also access the plan’s Healthy Pantry Benefit, which offers up to 12 monthly sessions with a Kroger Health dietitian who can provide nutritional education support, and they can receive a monthly delivery of pantry staples. In addition, Kroger Health’s 2,200 pharmacies are in Anthem’s preferred network.

A diversified portfolio was the name of the game late last month as publicly traded insurers discussed third-quarter 2021 earnings and braced for the return of Medicaid eligibility redeterminations, which could happen anytime after the latest public health emergency extension runs out in mid-January 2022. Despite a surge in COVID-19 costs in the quarter, Anthem, Inc., Centene Corp. and Molina Healthcare, Inc. all delivered better-than-anticipated earnings, which they attributed in part to Medicaid enrollment growth as states continue to put off eligibility reverifications.

Reporting earnings on Oct. 27, Molina Healthcare, Inc. beat Wall Street projections by three cents with adjusted earnings per share (EPS) of $2.83 and a medical loss ratio (MLR) of 88.9%. The net effect of COVID increased the overall MLR by approximately 110 basis points and impacted all three lines of business (Medicaid, Medicare and Affordable Care Act marketplace), as the company experienced higher COVID-related inpatient costs that began to decline in late September. COVID led to increased medical costs in both the Medicaid and marketplace segments; while non-COVID utilization by exchange members who enrolled through the pandemic Special Enrollment Period also impacted the marketplace segment, there was a lower negative net effect of COVID among Medicare members.

The delivery of prepared meals, often triggered by a hospitalization, has played a steadily increasing role in Medicare Advantage plans’ efforts to manage members’ chronic conditions, but now the more nuanced area of nutrition is starting to gain traction as a supplemental benefit offering. Nutrition services vendors say offering healthy food options and education to at-risk members can result in major medical cost savings for plans.

According to a recent Avalere Health analysis of selected non-medical benefits offered by MA plans in 2022, 30% of plans will feature a nutrition benefit next year, compared with 17% of plans in 2021. For that analysis, Avalere focused on four benefit categories — meals, transportation, nutrition and in-home support services — differentiating nutrition as “general education and nutrition counseling from a practitioner (e.g., dietitian)” as opposed to pre-made meals that may be delivered to a patient’s home. The firm found that meals will be offered by 68% of MA plans next year, compared with 55% this year. The analysis excluded Special Needs Plans, many of which are promoting enhanced food benefits for 2022 (see story).