Radar on Medicare Advantage
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Medicare Advantage Enrollment Tops 28 Million in 2022 Annual Election Period
Approximately 2.2 million people enrolled in a Medicare Advantage plan from February 2021 to February 2022, bringing the total MA population to 28.6 million medical lives. That’s an 8.5% year-over-year increase, according to AIS Health’s analysis of data that included enrollment from the 2022 Medicare Annual Election Period (AEP), down from 9.9% growth during the prior-year period. Nearly two-thirds (64.3%) of all new enrollees selected a plan from UnitedHealthcare, Humana Inc. or CVS Health Corp.’s Aetna, while Centene Corp.’s major market expansion paid off, garnering more than 30% enrollment growth for the insurer. Meanwhile, Florida Blue parent GuideWell Mutual Holding Corp.’s completed acquisition of Triple-S Management Corp., one of the largest MA insurers in Puerto Rico, allowed it to crack the top 10 for the first time. Anthem, Inc. also completed a Puerto Rico MA deal with its July 2021 acquisition of MMM Holdings from InnovaCare Health. On the state level, four states saw MA growth of more than 20% (vs. 10 last year), including Delaware and Vermont, which have historically low penetration rates.
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SCAN, CCA Team Up to Support PACE Enrollees Through myPlace
As the pandemic underscores the importance of enhanced support for community-dwelling seniors with complex care needs, two not-for-profit Medicare Advantage organizations have teamed up to sponsor an “integrated care delivery organization” designed to serve enrollees who qualify for Programs of All-Inclusive Care for the Elderly (PACE). Long Beach, Calif.-based SCAN Health Plan and Boston-based Commonwealth Care Alliance (CCA) last month unveiled the launch of myPlace Health as part of their shared mission of keeping seniors healthy and independent.
Robbie Pottharst, CEO of the newly launched company, confirms that myPlace is seeking to become a PACE organization and align with local health plans that may already serve dual eligibles who qualify for PACE and that, in his words, “can lend capability, expertise and a lot of accelerators to build this business.” Pottharst previously held leadership roles with Cityblock Health, Kaiser Permanente and CareMore Health, where Sachin Jain, M.D., served as president and CEO before taking over the reins at SCAN.
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Slim Marketing Guidelines Stress Importance of Reviewing Regs
After nearly four years, CMS has released an updated version of the Medicare Communications and Marketing Guidelines (MCMG) that serve to interpret and provide guidance on the marketing and communication rules for Medicare Advantage and Part D sponsors. Compliance experts tell AIS Health, a division of MMIT, that the long-awaited document is light on additional guidance and clarification except for a few topics, and plans are encouraged to review all related regulations to stay compliant with marketing rules.
Aside from severely whittling down the document — the 2022 MCMG is now a mere 51 pages, down from 84 pages when last released as a full document for the 2019 plan year and 124 pages in the 2018 version — CMS has noticeably consolidated and reorganized sections, moving some subsections into other areas or removing guidance that was codified. The agency reminded plans that the document is to “be used in conjunction with the regulatory requirements to aid plans in understanding and complying with the regulations.”
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News Briefs: CMS Is Seeking Applicants for the 2023 MA VBID and Part D Senior Savings Models
CMS on March 1 issued a request for applications (RFA) for the 2023 Medicare Advantage Value-Based Insurance Design Model, which will include new elements such as a Health Equity Incubation Program that will encourage testing of interventions in “the most promising focus areas” (e.g., food insecurity) and designing best practices for such interventions. Thirty-four MA organizations are currently offering benefit packages that feature tailored VBID model benefits and rewards and incentives to more than 3.7 million enrollees, according to the model’s website. CMS on Feb. 28 also released an RFA from Medicare Part D sponsors and pharmaceutical manufacturers interested in participating in the 2023 Part D Senior Savings Model. Now in its third year, the insulin-focused model is intended to lower out-of-pocket costs for seniors by featuring “predictable” copayments of no more than $35 for a broad set of insulins. The voluntary model has 106 participants, including five manufacturers. CMS is accepting applications for the VBID model through April 15 and for the SSM through April 8.
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InnovAge Stock Falls as Regulators Scrutinize PACE Operations
Despite better-than-expected financial results posted for its fiscal-year 2022 second quarter, shares of InnovAge — the largest provider of Programs of All-Inclusive Care for the Elderly (PACE) — tumbled last week amid concerns about its ability to grow in the face of intensifying regulatory scrutiny. Between federal audits and issues with its state partners, InnovAge’s many struggles relate to program compliance and may demonstrate the difficulties of scaling up a specialized care model in a highly regulated industry.
Providing services primarily through a dedicated center, PACE organizations support frail, elderly Americans who require a nursing-home level of care by offering comprehensive medical care and social supports to help them remain at home. The PACE market serves about 51,000 participants, most of whom are dually eligible for Medicare and Medicaid, and it is largely composed of regional organizations. As the dominant PACE organization, InnovAge serves 12% of that market.
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