Membership Growth

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.

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.

PACE Is Poised for Expansion as COVID Highlights Home Needs

As Congressional lawmakers consider additional funding for home and community-based services (HCBS) in Medicaid and the pandemic underscores the importance of enhanced support for community-dwelling seniors, a small but growing segment of the Medicare market is experiencing a resurgence. Programs of All-Inclusive Care for the Elderly (PACE) are designed to support frail, elderly Americans who require a nursing home level of care by providing comprehensive medical care and social supports to help them remain at home, and sources tell AIS Health that PACE competition is heating up as more venture capital firms look to invest in PACE organizations and as multiple states expand their programs.

PACE Market Sees Steady Growth, Diverse Pool of Providers

Enrollment in Programs of All-Inclusive Care for the Elderly (PACE) topped 51,000 people in 2021, according to AIS’s Directory of Health Plans, representing a small but impactful segment of the Medicare market that’s seen consistent annual growth. Notably, no large national entities have a significant PACE presence, leaving regional actors to control the market. The largest PACE organization, InnovAge, enrolls just 12% of all lives, and the average PACE organization enrolls about 430 participants, per AIS data. There will be 14 new PACE plan IDs on the market in 2022, according to research from Clear View Solutions, LLC, up from 12 in 2021. And just two IDs have exited the market for 2022, Clear View found. See an overview of the current PACE market below.

Medicaid Managed Care RFP Radar: What’s Ahead for 2022

With several states issuing requests for proposals (RFPs), 2022 is shaping up to be a solid year for payers pursuing new Medicaid contract awards. Iowa is looking for up to four MCOs to serve Iowa Health Link, up from its current two, and Tennessee’s awards could come by year-end. As for the most hotly competitive RFPs, eyes will be on California and Texas as they prepare to begin the procurement process for contracts that will cover about 3.5 million and 4.3 million lives, respectively. Meanwhile, previous contract awards in Kentucky, Louisiana and the District of Columbia have caused considerable controversy and sparked ongoing legal challenges between payers and state Medicaid officials, prompting rebids. Below, see an overview of key RFPs that are expected to be issued or awarded in the coming months.

Medicare Advantage Insurers Step Up SNP Offerings for 2022, Particularly for Duals

As Medicare Advantage enrollment soars and the number of individual MA plans available across the U.S. reaches a new high for 2022, the MA Special Needs Plan market is also seeing continued growth. According to estimates from Clear View Solutions, LLC, there will be 926 plans available next year that were offered in 2021, compared with 766 plans that carried over from 2020 to 2021 (see infographic). Dual Eligible SNPs (D-SNPs), in particular, will rise from 477 plans offered in 2020 and 2021 to 569 plans available this year and next, according to the consulting firm’s analysis of the 2022 SNP Landscape files from CMS.

Given COVID Surge, Humana Deviates From Peers With Lower Guidance

Like the other publicly traded insurers that reported third-quarter 2021 earnings late last month, select Medicare Advantage insurers in early November demonstrated strong performances during a quarter that was tainted by a rise in COVID-related costs. Unlike its more balanced peers, however, MA-focused Humana Inc. took a decidedly conservative approach to projecting earnings for the full year given continued COVID uncertainty.

Clover Health Struggles to Contain Medical Costs for MA Members

Of the newly public startup insurers that reported third-quarter 2021 earnings, all four posted higher (worse) medical loss ratios (MLRs) compared with the prior-year quarter — a direct result of higher COVID-related costs. The two insurers with a focus on Medicare Advantage, however, demonstrated wildly different experiences, with Clover Health Investments Corp.’s MLR clocking in at 102.5%, while Alignment Healthcare, Inc.’s 85.7% MLR was more in line with those of the larger, established insurers.

Payers Are Increasingly Attracted to Growing SNP Market

From 2017 to 2021, the number of people enrolled in Special Needs Plans (SNPs) grew 69.2%, topping 4.1 million lives, according to the latest update to AIS’s Directory of Health Plans. D-SNPs saw the most growth, a whopping 79.3% increase to 3.7 million lives, followed by I-SNPs (+31.9%), then C-SNPs (+16.6%). Meanwhile, plans have grown to meet that surge, with the total number of SNP offerings expanding from 498 to 926 plans in the same time period, per an analysis of CMS’s Landscape files from Clear View Solutions, LLC.