Radar on Medicare Advantage

InnovAge Replaces CEO After CMS Imposes Second Enrollment Freeze on the PACE Organization

Shortly after Denver-based InnovAge learned that CMS suspended enrollment in the company’s Colorado programs due to noncompliance, the leading Programs of All-Inclusive Care for the Elderly (PACE) provider unveiled the resignation of its longtime CEO, Maureen Hewitt. InnovAge serves more than 6,300 PACE participants, or 12% of PACE enrollees overall, and is in the midst of a major expansion. The company on Jan. 3 said Hewitt was leaving to “pursue other opportunities” and it promoted Patrick Blair, the current president, to president and CEO.

InnovAge in March 2021 began trading on the Nasdaq Global Select under the ticker symbol “INNV,” and at the time said it planned to expand its footprint of 16 centers in five states. The company in November said it expected to open three centers in fiscal year 2023 and was looking at additional locations and eyeing acquisitions in new markets.

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News Briefs: Centene Completes Acquisition of Magellan Health | Jan. 6, 2022

Centene Corp. completed its $2.2 billion acquisition of Magellan Health, Inc. The previously announced deal will allow Centene to expand its behavioral health platform, increase its specialty health and pharmacy capabilities, and enhance its ability to address members’ whole health. Magellan Health will operate independently under Centene’s Health Care Enterprises umbrella, with CEO Ken Fasola and other members of Magellan Health’s leadership team continuing to lead the organization, Centene said on Jan. 4.

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2021 in Review: Top 25 Medicare Advantage Insurers Enroll Nearly 90% of Market

The top 25 Medicare Advantage insurers enroll a combined 24.3 million lives, or 87.8% of the national market, according to the December 2021 update to AIS’s Directory of Health Plans. That’s up from 21.4 million lives at year-end 2020. Among the large national insurers, Centene Corp. saw staggering growth of nearly 40%, fueled by the insurer’s significant 2021 market expansion, followed by Anthem, Inc. at 30.7%. Anthem completed its acquisition of InnovaCare Health’s MMM Holdings, the largest MA organization in Puerto Rico, in July 2021. Highmark Health and Molina Healthcare also completed deals that boosted their MA presence this year. Just one insurer in the top 25, Triple-S Management Corp., saw an enrollment loss, though it was less than 1%. See the complete list in the table below.

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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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News Briefs: UnitedHealth Group Forecasts 2022 Earnings | Dec. 2, 2021

Providing its first glimpse of earnings for 2022, UnitedHealth Group at its Nov. 30 Investor Conference said it expects to achieve revenue in the range of $317 billion to $320 billion and adjusted net earnings per share (EPS) of $21.10 to $21.60. Its UnitedHealthcare division is expected to contribute $245.5 billion to $247.5 billion, driven in part by the anticipated addition of 600,000 to 650,000 net new Medicare Advantage members, reflecting year-over-year growth of 9% to 10%.

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News Briefs: New MA and Part D Rule Is Pending at OMB | Nov. 18, 2021

The Biden administration’s first Medicare Advantage and Part D regulation is pending review at the Office of Management and Budget. The CMS final rule, titled “Policy and Technical Changes to the Medicare Advantage Program and Medicare Prescription Drug Benefit Program; MOOP and Cost Sharing Limits (CMS-4190),” was received on Nov. 10. It is not economically significant, according to the posting at RegInfo.gov.

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Nutrition Makes Headway as MA Supplemental Benefit for 2022

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.

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Three Major Medicaid Insurers Report 3Q Gains Despite COVID Surge

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.

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Industry Groups Get in Front of Potential Medicare Advantage Cuts

As progressives seek to keep some expansion of Medicare benefits in the president’s shrinking budget reconciliation package, industry-allied organizations have been building public-facing campaigns to protect Medicare Advantage from any “cuts.” Provisions to add dental and vision benefits to Medicare were removed from the latest text of the Build Back Better Act — likely giving MA plans less to worry about — while progressive lawmakers at press time were intent on getting drug pricing provisions into a final measure.

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Select Insurers Enhance Grocery Allowances, Nutrition Benefits for Duals Next Year

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.

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