AIS’s Directory of Health Plans

Datapoint: Elevance Loses Out on Kentucky Medicaid Contract Case

The Kentucky Supreme Court last week ruled against Elevance Health’s challenge to the state’s Medicaid contract awards, according to the Kentucky Lantern. Elevance argued the state’s bidding process was flawed when it lost out on its contract renewal, in a case that dates back to 2019. The insurer’s Anthem Health Plans of Kentucky currently serves 185,561 Medicaid and CHIP members in the state, about 12% of the managed Medicaid population. The state’s remaining contracted Medicaid insurers are CVS Health’s Aetna, Humana Inc., Passport Health Plan, UnitedHealthcare and Centene Corp.’s WellCare.

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Datapoint: Cigna Expands GLP-1 Program to Limit Payer Costs

Cigna’s pharmacy benefit management unit Evernorth is updating its EncircleRx program to include an “industry-first financial guarantee” for employer clients that choose to cover glucagon-like peptide-1 (GLP-1) receptor agonists, the injectable “cardiodiabesity” drugs that have kept the industry buzzing since their inception. “[EncircleRx] offers employers and health plans greater predictability and control of their GLP-1 spend,” Adam Kautzner, president of Express Scripts and Evernorth Care Management, said in a statement. The expanded program will offer employers a cost cap or savings guarantee on GLP-1 spend. Cigna is one of the largest commercial insurers in the U.S., serving 13.8 million members via self-funded contracting arrangements, and an additional 2.2 million lives in employer group risk-based products.

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Datapoint: CMS Updates Elevance Star Ratings

CMS informed Elevance Health, Inc. that four of the company’s Medicare Advantage contracts will have a higher 2024 Star Rating after the agency updated the original ratings it announced in October 2023. The insurer said in a March 4 filing with the Securities and Exchange Commission that it now estimates it will have approximately 49% of its MA members enrolled in plans with at least 4 Stars for 2024, based on January 2024 enrollment. CMS’s Star Rating revision, Elevance predicted, will result in a 2025 financial benefit of approximately $190 million. Elevance is currently the fourth-largest MA insurer nationally, with 1,975,035 members.

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Datapoint: DOJ Reportedly Investigating United’s MA Practices

The U.S. Dept. of Justice (DOJ) has reportedly launched an antitrust investigation into UnitedHealth Group that includes an examination of its Medicare Advantage risk coding practices. According to a Wall Street Journal report citing unnamed people familiar with the matter, the DOJ has been seeking information such as how UnitedHealthcare interacts with provider groups acquired by its Optum division in recent years. Regulators are also looking into MA billing issues, “including the company’s practices around documenting patients’ illnesses.” With 9.3 million members, UnitedHealthcare is by far the largest MA insurer in the U.S. It grew 1.6% during the latest Medicare Annual Election Period, a noticeable slowdown from previous years.

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Datapoint: 2024 Medicare Advantage AEP Nets 4% Growth

An additional 1.27 million people enrolled in Medicare Advantage between October 2023 and February 2024, the time period that captures the full impact of the Annual Election Period (AEP), according to AIS’s Directory of Health Plans. That’s a 4% increase in overall enrollment, down from 4.6% in 2023 and 5.3% in 2022. While enrollment is still growing, this represents a significant slowdown from the pandemic-era MA boom.

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Datapoint: South Dakota Will Vote on Medicaid Work Requirements

South Dakota voters will decide in November whether the state can impose Medicaid work requirements on its expansion population, per a measure passed by the state legislature. Voters chose to bring Medicaid expansion to the state in the November 2022 elections. While the current measure says the government “may not impose greater or additional burdens or restrictions on eligibility or enrollment standards,” the new ballot initiative would add “who has not been diagnosed as being physically or mentally disabled” to that language. South Dakota currently serves 103,098 Medicaid beneficiaries.

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Datapoint: CareSource Strikes Deal With Wisconsin Co-op Plan

CareSource last week struck an affiliation deal with Brookfield, Wis.-based Common Ground Healthcare Cooperative, one of the few remaining Affordable Care act co-op plans, which are governed by their members. “It’s challenging as a nonprofit startup to support necessary investments in operations and diversification while keeping premiums affordable for our members,” Common Ground CEO Cathy Mahaffey said in a statement. "After years of searching, I’m grateful we've found the perfect partner in CareSource that will enable us to continue our focus on the members we serve.” Common Ground currently serves 61,575 individual and small group members in Wisconsin. With more than 2.2 million members, CareSource is primarily a Medicaid insurer, but also enrolls 188,187 people in individual plans in six states.

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Datapoint: Virginia Awards New Medicaid Contracts

Virginia’s Department of Medical Assistance Services (DMAS) on Feb. 29 awarded Medicaid contracts to Aetna, Elevance Health, UnitedHealthcare, Humana Inc. and Sentara Health Plans. Four are incumbents to the program, while Humana is a new entrant. Molina Healthcare, which currently serves 106,305 managed Medicaid and CHIP members in Virginia, was not selected for a renewal. The contracts are slated to begin this summer. Virginia currently serves 1.62 million Medicaid beneficiaries, with 96.3% enrolled in managed care plans.

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Datapoint: Elevance Launching Weight Management Program

Elevance Health’s PBM unit CarelonRx is launching a digital-first weight loss management program in the coming weeks, according to a Feb. 26 press release. The program will grant participants access to digital coaching and wellness tools, plus live support for managing and monitoring weight loss goals. Participants who are prescribed GLP-1s will be able to use an additional companion module “designed to provide medication management support with a member’s prescribing physician.” The program will be available to ASO integrated clients, according to Elevance. Elevance is currently the second-largest self-funded insurer in the U.S., with 20,166,000 ASO members.

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Datapoint: Aetna Sees Strong MA Growth

CVS Health’s Aetna grew its Medicare Advantage rolls by 18.9% during the annual enrollment period, according to the latest public-sector update to AIS’s Directory of Health Plans. It’s the most growth of any large carrier by a wide margin, beating out MA stalwarts Humana Inc. (3.1% growth) and UnitedHealthcare (1.6% growth). Aetna expanded its footprint to 255 new counties for the 2024 plan year, offering new $0 premium plans and enhanced products for dual eligibles. The payer currently ranks third nationally in MA enrollment, serving 3,970,500 members.

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