Radar on Medicare Advantage

  • 2021 Landscape Presents Myriad Choices, Benefits in MA

    With its annual release of the so-called landscape files for the Medicare Advantage and Part D programs, CMS on Sept. 24 estimated that enrollment in MA will jump 10% to an “all-time high” of 26.9 million beneficiaries, while the average monthly MA plan premium will drop 11% to an all-time low of $21.00. Meanwhile, beneficiaries shopping during the 2021 Medicare Annual Election Period (AEP) that starts Oct. 15 will be inundated with choices, from the sheer number of plans available to a plethora of supplemental benefits.

    CMS, in its Sept. 24 press release accompanying the unveiling of the landscape files, estimated that MA beneficiaries will have an average number of 47 plan choices per county, up from about 39 in 2020 and 33 in 2019. The agency added that the number of plan options in rural counties next year will increase by about 18% to 2,900, “as a result of flexibilities we gave to plans on benefit coverage and building their provider networks.”

  • News Briefs

     The overall average scores for Medicare Advantage and Part D organizations subjected to 2019 program audits dropped from 1.03 in 2018 to 0.77, according to the 2019 Part C and Part D Program Audit and Enforcement Report. Published on Sept. 14, the same day as the early release of Part 1 of the Advance Notice (see story, p. 1), the Medicare Parts C and D Oversight and Enforcement Group (MOEG) estimated that CMS imposed a total of $1.6 million in civil monetary penalties on eight sponsors in 2019. That was the first year of the third audit and covered approximately 71% of MA and Part D enrollees. Compared with the 2018 program audits, sponsors showed the greatest improvements in the areas of Compliance Program Effectiveness and Medicare-Medicaid Plan Service Authorization Requests, Appeals and Grievances. The average number of conditions cited per audit in 2019 was 11, compared with 38 in 2012, observed MOEG. Visit https://go.cms.gov/2GXhPyN.

     Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) has partnered with health system Hackensack Meridian Health to offer a Medicare Advantage plan for 2021. The jointly operated plan, Braven Health, will also feature RWJBarnabas Health, subject to approval by the New Jersey Dept. of Banking and Insurance. It will offer MA plans in eight New Jersey counties with a “broad provider network anchored by Hackensack Meridian Health and that includes all health care professionals who participate in Horizon BCBSNJ’s managed care network,” according to a Sept. 14 press release. Visit www.bravenhealth.com.

  • SNP Enrollment Cuts Mortality, Utilization Rates for ESRD Patients

    Medicare beneficiaries with end-stage renal disease (ESRD), a costly and complex population that often has other comorbidities and sees multiple physicians, may be better served in ESRD Special Needs Plans, a type of Chronic-Condition SNP, posits a new study in Health Affairs. Researchers studied members of Anthem, Inc.’s California-based CareMore Health ESRD SNPs from 2010 to 2013, and found that those who switched from fee-for-service Medicare to a CareMore SNP experienced reduced risk of death and overall lower health care utilization compared to the FFS population (see graphics below). SNPs can coordinate member care more closely, leading to improved adherence and better health outcomes, which in turn reduces costs, asserted the study, which was supported by a grant from the Anthem Public Policy Institute. The study authors — which included employees of Humana Inc. and Anthem/CareMore — said that while additional research is still needed, CMS could consider facilitating “the sharing of best practices across SNPs and to other ESRD delivery and financing models” as it considers new models of care, including the enrollment of ESRD patients in traditional Medicare Advantage plans starting in 2021.
  • Tenn. Blues Plan Gives PCPs High Marks for Quality

    For the fifth year in a row, BlueCross BlueShield of Tennessee (BCBST) recently celebrated the achievements of hundreds of high-performing primary care physicians in its PPO network. The provider engagement effort is part of an enterprise-wide initiative that has helped the insurer maintain a 4-star rating from CMS for its Medicare Advantage PPO plan while observing continued population-level improvement on key quality metrics, including patient experience measures that will soon receive an increased weighting in the CMS star ratings program.

    In an Aug. 17 press release, the insurer named 43 providers and practices across the state who earned a 4.5 out of 5 star rating in BCBST’s Medicare Advantage 2019 Quality+ Partnerships Program. One of them, Charles A. Ross, M.D., of Kingsport, earned a 5-star rating. Many more physicians and practices were recognized on the insurer’s website for achieving a rating of 4 stars or higher. BCBST serves approximately 157,000 MA enrollees overall, including 138,000 lives in its PPO plans.

  • Safety Net Plans Seek ‘Hold Harmless’ Policies From CMS

    As the COVID-19 pandemic continues to shake up the health care system — and disproportionately impact vulnerable patients such as dual eligibles enrolled in Medicare-Medicaid Plans (MMPs) or Special Needs Plans (SNPs) — the Association for Community Affiliated Plans (ACAP) is calling on CMS to extend a multitude of flexibilities that will allow such plans to access the resources they need to continue serving at-risk members.

    These plans “are bearing the brunt of the pandemic specifically because their enrollees are more at risk,” wrote ACAP CEO Margaret Murray in a Sept. 3 letter to Center for Medicare Principal Deputy Administrator and Director Demetrios Kouzoukas. ACAP’s not-for-profit health plans collectively provide coverage to 20 million Medicaid, CHIP, dual-eligible and exchange enrollees, and they enroll more than one-third of the total MMP membership nationwide. “Overall, we are asking CMS to hold MMPs and SNP harmless to mitigate the effects of COVID-19 on plan operations,” she wrote, adding that how some changes are applied may vary by geographic region.

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