For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face a host of unknowns — such as potential risk adjustment and star ratings changes that could impact plan revenue — and challenges that include staying competitive in an increasingly rich benefits landscape. For AIS Health’s annual roundup of perspectives on the year ahead, industry experts weigh in on how doing business in 2022 might differ from previous years.

AIS Health: What do you view as some of the biggest challenges or uncertainties facing MAOs in 2022?

Although the pandemic-driven economic crisis led to a massive increase in unemployment, loss of commercial health coverage has not been as great as predicted, and enrollment has rebounded over the past year. Meanwhile, the launch of a special enrollment period for the federal health insurance exchange and the temporarily expanded premium subsidies in the individual market led to membership growth in managed Medicaid and exchange plans, according to AIS’s Directory of Health Plans. Among the top five Blue Cross Blue Shield plans, all but BCBS of Illinois saw enrollment increases compared with December 2020.

Humana Inc. said it is decreasing its net membership growth estimate for its individual Medicare Advantage products, sending the insurer’s stock tumbling. In a Jan. 6 filing with the Securities and Exchange Commission, Humana said it now expects to add 150,000 to 200,000 members to its individual MA plans in 2022, down from a range of 325,000 to 375,000 members. The company said its revised estimate “is primarily attributable to higher than anticipated terminations during the AEP [annual election period], combined with the expectation of higher than originally projected terminations for the remainder of 2022.”

For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face a host of unknowns — such as potential risk adjustment and star ratings changes that could impact plan revenue — and challenges that include staying competitive in an increasingly rich benefits landscape. For AIS Health’s annual roundup of perspectives on the year ahead, industry experts weigh in on how doing business in 2022 might differ from previous years.

AIS Health: What do you view as some of the biggest challenges or uncertainties facing MAOs in 2022?

With continued emphasis on member experience, several new Part C measures and a directional shift to closing health care inequities, 2022 stands to be a landmark year in terms of changes to Medicare Advantage organizations’ star ratings strategies, industry experts tell AIS Health, a division of MMIT.

“There is so much earth-shattering change on the horizon that most plans are just not thinking about,” cautions Melissa Newton Smith, executive vice president, consulting and professional services with Healthmine, Inc. “We’re worried that COVID took up way too much airtime and that plans have lost sight of the forest through the trees in MA a little bit.”

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.

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.

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.”

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%.