RADAR on Medicare Advantage

News Briefs: For 2023, UnitedHealth Group Expects Its Overall Medicare Advantage Enrollment to Jump 9%

UnitedHealth Group at its annual Investor Day projected strong Medicare Advantage membership growth of 9% next year, overall revenues in the range of $357 billion to $360 billion and earnings per share between $24.40 and $24.90. Along with financial projections shared on Nov. 29, the company said it expects to serve a total of 7.1 million MA members by the end of 2022, and estimated that figure will grow by another 600,000 to 650,000 next year. That year-over-year growth of 9% reflects a “blended projection across Individual MA and Group MA books,” wrote Barclays Steve Valiquette in a research note. “As such, we expect that Individual MA growth is likely higher than the blended 9% (likely in the low-double-digit range) which remains slightly above market growth.” He also noted that UnitedHealth’s projected medical loss ratio of 82.6% (give or take 50 basis points) was “slightly more conservative than expected” but not surprising given that the company said its MLR guidance reflects an expectation of a slightly elevated flu season in early 2023.

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States Seek Integrated Services and Health Equity in Pending Medicaid RFPs

The latest round of current and upcoming state requests for proposals (RFPs) is continuing a sea change toward integrated care and greater health equity in managed Medicaid programs. Several states are redesigning their programs altogether, with a focus on integrating physical and behavioral health, as well as addressing social determinants of health. New Mexico’s new Turquoise Care program will combine physical health, behavioral health and long-term care services, while Oklahoma will incorporate managed care into its Medicaid program for the first time in 2023. Notably, the state is soliciting bids from both MCOs and provider-led entities to integrate physical health, behavioral health and prescription drug services. Moreover, Georgia and Virginia both hinted at upcoming program changes as they prepare to release RFPs within the next year, with Georgia recently asking stakeholders how it could improve health care in underserved communities. Texas, meanwhile, in the second quarter of 2023 will unveil what’s sure to be a hotly contested RFP — its managed care plans currently serve more than 5 million people. See an overview of key RFPs that are expected to be issued or awarded in the coming months in the table below.

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Memory Fitness Offerings Jump 38% as MA Insurers Promote Mind-Body Wellness

Nearly three years ago, when insurers were in the early days of experimenting with new offerings under CMS’s reinterpretation of “primarily health related” supplemental benefits, very few plans were offering benefits specifically geared toward “memory fitness.” Now, a new Faegre Drinker analysis shows that these benefit offerings will be featured in more than 1,300 plan benefit packages (PBPs) next year — an increase of 38% over 2022.

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News Briefs: CMS Extended Plans to Issue a Final Rule on Extrapolation in RADV Audits

CMS is buying itself more time to make a final determination about its use of extrapolation in Risk Adjustment Data Validation (RADV) audits. In a Federal Register notice, the agency pushed its Nov. 1 deadline to issue a final RADV rule to Feb. 1, 2023, saying it was unable to meet the already extended deadline “because of ongoing exceptional circumstances.” The Trump administration in a November 2018 proposed rule (83 Fed. Reg. 54982, Nov. 1, 2018) said its plans to recoup improper payments starting with payment year 2020 would not involve a “fee-for-service adjuster” and that it may apply this extrapolation methodology when finalizing audits dating back to payment year 2011. That rule received pushback from insurers for its potential to inflate audit recoveries, skew the MA bidding process and impact beneficiary cost-sharing and MA product offerings. The provision was not finalized by the Trump administration. CMS in October 2021 extended the statutory three-year timeline for completing the rulemaking, explaining that it received extensive public comments on the proposal and the FFS adjuster study that it released just prior to publishing the November 2018 proposed rule.

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South Dakota Could Be the Last State to Expand Medicaid for Foreseeable Future

A South Dakota ballot initiative that would finally bring Medicaid expansion to the state triumphed in the midterm elections, passing with 56% of the vote. It’s the latest in a string of successful ballot initiatives in expansion holdout states — and perhaps the last. While there have been rallying cries of support for expansion in some of the 11 remaining holdout states, the efforts of Democratic governors and organizing committees working to get expansion on future ballots have been stymied for years.

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MedPAC Mulls Concept of Standardizing Common Supplemental Benefits in MA

As Medicare Advantage insurers continue to grow their supplemental benefits offerings and CMS maintains a focus on improving the consumer experience, the Medicare Payment Advisory Commission (MedPAC) has begun work on the nascent concept of standardizing certain benefits in MA. During its Nov. 4 public meeting, the commission seemed mostly interested in standardizing a limited number of common supplemental benefits in the name of helping beneficiaries make better plan comparisons, but several commissioners expressed concern about potentially hampering MA plan innovation.

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GOP-Controlled House Could Eye MA Overpayments, ‘Questionable’ Marketing

With a few midterm races unresolved as of mid-November, Democrats are projected to narrowly retain control of the Senate while Republicans will take back the House in the next Congress. That raises numerous questions about the future of health care policy, but D.C. insiders say House Republicans are likely to pursue achievable items rather than reach for the stars. Regardless of who controls each chamber, however, the experts suggested that more accountability and oversight is expected in Medicare Advantage.

“For once, repeal and replace isn’t the defining backbone of Republican health policy in Congress,” said Tarplin, Downs & Young Partner Jennifer Young, referring to multiple GOP efforts to scrap the Affordable Care Act, during a Nov. 4 webinar hosted by Kaiser Family Foundation (KFF). “It took us years, but I think we have learned that repeal and replace was not a winning issue and I think there’s been an acknowledgment that a Democratic president…isn’t likely to sign repeal and replace into law,” said Young, who served as assistant secretary for legislation at HHS and senior counselor to then-Secretary Mike Leavitt during the George W. Bush administration.

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Senate Democrats Push for MA Marketing Fixes, but Not All May Be Feasible

After releasing the results of their multistate probe into the marketing practices of Medicare Advantage plans and their partners, Senate Finance Committee Democrats are urging CMS to enhance its oversight of MA marketing and issue “commonsense” regulations as soon as possible. The report, Deceptive Marketing Practices Flourish in Medicare Advantage, illustrated dozens of “aggressive marketing tactics” in 14 states and advised CMS to take various measures within its regulatory reach. But industry experts tell AIS Health, a division of MMIT, that not all recommendations may be doable in the near term. And they say it’s likely CMS will see how recent efforts fare before pursuing steps such as prohibiting MA organizations from contracting with entities that purchase lists of leads.

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Top Stars Performers Credit Careful Messaging, Provider Collaboration

As CMS resumed normal Star Ratings calculations and gave greater weight to patient experience measures for 2023, the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning 4 stars or higher saw a dramatic drop from 2022, according to newly released CMS data. In Part 2 of an AIS Health series on successful Star Ratings strategies, top performers say maintaining a company-wide focus on quality and member experience is key to their approach. And while member outreach is a critical part of those initiatives, successful plans are careful to avoid overcommunicating with members and creating message fatigue, sources tell AIS Health, a division of MMIT.

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CMS Spooks MA Plans With Warning About Secret Shopping, Enhanced Monitoring

If Medicare Advantage organizations and Prescription Drug Plans (PDPs) this open enrollment season have the haunting feeling they’re being watched, it’s because they are. After implementing new rules aimed at better protecting beneficiaries from confusing and misleading Medicare marketing, CMS in October issued two memos informing plans that they’ve done some digging into recent marketing activities and they don’t like what they’ve seen so far.

CMS has reported that marketing-related complaints more than doubled between 2020 and 2021 — which it largely attributed to the actions of third-party marketing organizations (TPMOs) — and has expressed particular concern with third-party marketers’ claims that some benefits are widely available to seniors when they vary by service area. To address these concerns, CMS made key changes this year, such as requiring TPMOs to use a standardized disclaimer that they do not offer every plan available in the area, clarifying that independent agents and brokers qualify as TPMOs, and stipulating that plans in their contracts with TPMOs require full recordings of sales calls with beneficiaries.

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