Membership Growth

News Briefs: Switch Rate From FFS Medicare to MA Peaked at 7.8% in 2021, Research Finds

As Medicare Advantage attracts a greater share of Medicare-eligible enrollees, switching from fee-for-service Medicare to MA has been on the rise since 2010 and peaked at 7.8% in 2021, according to new research published in Health Affairs. Researchers used data from the CMS Medicare Enrollment Database and the Risk Adjustment Processing System, and their primary objective was to understand where the bulk of new MA membership is coming from (i.e., FFS Medicare vs. new-to-Medicare) and those individuals' health profiles. After 2010, switching from MA to FFS Medicare consistently declined while switching in the other direction increased, with the greatest difference in rates occurring in 2021, when just 1.2% of individuals left MA for FFS Medicare, according to the analysis. (The switching rate was defined as the percentage of switchers out of the total number of switchers and stayers in either FFS Medicare or MA.) Between December 2021 and December 2022, the overall switching rate from FFS to MA averaged 7.4%, and men had a higher switching rate than women, researchers observed. During that time, the switch rate from FFS to MA was highest for Black beneficiaries (15.6%), closely followed by Hispanic beneficiaries (15.0%), and the lowest rate was among white enrollees (6.4%). Researchers noted their analysis was descriptive in nature and that they were not able to discern the underlying factors driving the observed switching patterns, such as aggressive marketing or attractive plan benefits. Moreover, the analysis did not differentiate between voluntary and involuntary switching. As the MA program continues to grow, however, “understanding reasons for switching will become important,” they observed.

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For Some Insurers, Inflation Reduction Act’s Anniversary Is Reason to Celebrate

When the Biden administration celebrated the one-year anniversary of the Inflation Reduction Act on Aug. 16, the focus — from a health care perspective — was largely on the IRA’s unprecedented drug pricing reforms. While those provisions are important to the health insurance industry, the sector has also seen an overwhelmingly positive impact from the law’s extension of beefed-up subsidies for Affordable Care Act exchange enrollees.

“We at ACHP and all of our members worked incredibly hard to get the health care provisions of the Inflation Reduction Act passed,” Alliance of Community Health Plans (ACHP) President and CEO Ceci Connolly tells AIS Health, a division of MMIT. “Potentially the most significant health care provision in that act was the extension of the enhanced subsidies for working Americans to buy coverage and care on the individual exchange.”

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mPulse Infuses Behavioral Science Into Text-Based Outreach to Medicaid Members

As Medicaid managed care organizations look to assist states with ensuring enrollees maintain coverage throughout the redetermination process, text messaging is often seen an effective way to reach members whose only method of communication may be a smartphone. During an Aug. 9 webinar hosted by Medicaid Health Plans of America, mPulse Mobile Chief Marketing Officer Brendan McClure said the technology company has reached out to more than 7 million members this year on behalf of its Medicaid plan clients.

The engagement solutions provider divides its phone-based outreach efforts into two main categories:

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Medicaid MCOs Try Multiple Touchpoints to Boost Redetermination Awareness

Effective April 1, states were allowed to begin disenrolling people from Medicaid who no longer qualify after a multiyear pause during the COVID-19 public health emergency (PHE). Yet data from the federal government suggests many people are losing coverage for procedural reasons, and surveys show a concerning lack of awareness regarding the redetermination process. Medicaid managed care organizations say they are working to supplement outreach efforts from state and federal agencies and are trying a variety of tactics to activate impacted members, including text messaging and notifications at the pharmacy. Since the start of redeterminations, CMS has clarified that states may rely on MCOs to assist enrollees with completing and submitting renewal forms and even pay them for this type of work.

KFF estimates that at least 4.77 million Medicaid beneficiaries have been disenrolled as of Aug. 15, with three quarters of disenrollments occurring for procedural reasons. HHS had previously estimated that 8.2 million people will no longer qualify for Medicaid once redeterminations resumed and find other coverage, while 6.8 million Medicaid enrollees could lose coverage despite still being eligible.

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MAOs Reporting 2Q Financials Factored Rising Utilization Into 2024 Bids

After a handful of publicly traded insurers last month reported second-quarter 2023 earnings that reflected the impact of increasing utilization, additional insurers reporting results in August said they witnessed a similar phenomenon, particularly among the Medicare Advantage population. But the insurers indicated that they were able to factor those trends into their bids for the coming plan year, while analysts were reassured that the issue was largely confined to MA and not the commercial sector.

UnitedHealth Group first disclosed the uptick in outpatient care utilization in June, sparking an insurer-stock selloff. Shortly after, Humana Inc. revealed in an 8-K filing with the U.S. Securities and Exchange Commission that it was also seeing elevated medical costs due to an increased use of services. Humana in that filing projected its insurance medical loss ratio (MLR) for the full year would settle in the higher (worse) end of its previously stated 86.3% to 87.3% range. “This expectation is primarily driven by the emergence of higher than anticipated non-inpatient utilization trends, predominantly in the categories of emergency room, outpatient surgeries, and dental services, as well as inpatient trends that have been stronger than anticipated in recent weeks, diverging from historical seasonality patterns,” the MA-focused insurer stated. The company also explained that it was seeing strong growth in its MA membership, including a “higher-than-expected proportion of age-ins” during the three-month Open Enrollment Period that ran from January to March, and such members tend to have an above-average MLR when compared to more established customers.

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‘Secret Shoppers’ Find People Losing Medicaid May Encounter Raft of Misleading Marketing

Although health insurers have been vocal about their desire to transition people into Affordable Care Act marketplace plans if they lose Medicaid during the resumed redetermination process, a new “secret shopper” survey suggests those customers will encounter a thicket of aggressive marketing for limited-benefit plans that could ultimately leave them on the hook for massive medical bills.

Researchers at Georgetown University Center on Health Insurance Reforms (CHIR) conducted their survey between June 9 and June 30, 2023, creating two profiles for hypothetical Texas residents who were informed they’d be losing Medicaid due to income ineligibility. “Terri” is 22 years old with no pre-existing conditions, and “Lorraine” is 36 with high cholesterol. Both live in a two-person household and have an annual income of $25,000 — qualifying them for the maximum premium and cost-sharing subsidies the ACA marketplace can offer. That means they can access, theoretically, silver plans with a $0 monthly premium that cover an average of 94% of the cost of covered benefits.

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News Briefs: Uninsured Rate Hit Record Low in March

In March, the national uninsured rate hit an all-time low of 7.7%, according to new data from the Centers for Disease Control and Prevention. Citi analyst Jason Cassorla wrote in an Aug. 3 investor note that the low rate “is not surprising” since Medicaid continuous enrollment provisions enacted during the pandemic were still in effect at that time – as were enhanced Affordable Care Act marketplace subsidies and the “generally stable to improving employment rate.” However, now that states have been permitted to restart Medicaid eligibility checks, the uninsured rate is almost certain to go back up, he pointed out.

Amazon.com., Inc. is expanding its virtual care offering, Amazon Clinic, to all 50 states and the District of Columbia. “In addition to message-based consultations in 34 states, Amazon Clinic now supports video visits nationwide,” the retail giant said in an Aug. 1 press release. Amazon first rolled out Amazon Clinic last November, but it was not available in all states at that time. Customers using the Amazon Clinic can access services via the Amazon website or mobile app, where they can “compare response times and prices from multiple telehealth provider groups, complete an intake form, and connect with their chosen provider,” the release stated. Patients do not need insurance to access the Amazon Clinic’s services and it doesn’t accept insurance; but the release noted that “medication prescribed by clinicians may be covered by insurance.”

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News Briefs: Humana Raises Individual MA Membership Outlook to 825K Additions in ’24

Humana Inc. on Aug. 2 said it expects to enroll approximately 825,000 members in its individual Medicare Advantage products this year, adding another 50,000 members to its initial projections and reflecting year-over-year growth of 18%. For the quarter ending June 30, the MA-focused insurer reported adjusted earnings per share (EPS) of $8.94, up from $8.76 in the second quarter of 2022, and a medical loss ratio (MLR) of 86.3%, up from 85.8% a year ago. The company raised its full-year 2023 adjusted EPS guidance to “at least $28.25,” reflecting a 25-cent increase. Humana also highlighted “stabilizing” MA utilization based on its most recent claims activity and said it continues to predict a full-year MLR of between 86.3% and 87.3%.

CVS Health Corp. on Aug. 2 reported second-quarter 2023 consolidated revenues of $88.9 billion, including $26.7 billion in revenue for the health care benefits segment, and reflecting overall growth of 10.3% from the year-ago quarter. Adjusted operating income for the health care segment declined by nearly 20% from a year ago, partly because of increased outpatient utilization in Medicare Advantage when compared with pandemic-driven utilization levels in the prior year, CVS Health explained in a detailed earnings release. For the quarter ending June 30, the company recorded an MLR of 86.2%, compared with 82.7% in the year-ago quarter, and adjusted EPS of $2.21, down from $2.53 in the second quarter of 2022. CVS Health confirmed its adjusted EPS guidance range of $8.50 to $8.70.

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Opportunity Beckons for Provider Groups Seeking MA Plan Sponsorship

Provider groups that want to sponsor a Medicare Advantage plan have multiple avenues of entering the market and competing with large national players — including building a plan from scratch. But funding, state licensure and other regulatory requirements are key considerations before taking the leap, according to experts who spoke during a recent webinar hosted by Manatt Health.

“There are a lot of players in the market, and a lot of providers are trying to figure out if this is a good strategy for them,” said Paul Carr-Rollitt, partner with Manatt Health, during the July 20 webinar, Creating Provider-Sponsored Medicare Advantage Plans: Opportunities, Risks and Keys to Success.

As the MA market expands, there is increasing interest among provider-based groups — from hospitals, health systems and physician associations — to make an entrance. While the market is currently “dominated by a few key players” and considered “highly concentrated,” that doesn’t mean provider-sponsored groups that are intrigued by the idea must be forced to the sidelines, Carr-Rollitt said.

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Payers Will Need to Shift Strategies as Medicare Advantage Boom Slows

Medicare Advantage enrollment growth has exploded in recent years, topping 31 million lives as of July 2023, according to AIS’s Directory of Health Plans. But a new analysis from McKinsey and Company warns this free-for-all won’t last forever, and payers will have to adjust their strategies and evolve to meet a changing market.

The consulting firm estimated that annual growth in MA membership will slow to 3% in 2031, a far cry from the 8% rate seen in 2022. That’s largely because MA’s market strongholds — which McKinsey says are primarily urban — will become too saturated over time. While 2023 marked the first time more than 50% of seniors were enrolled in MA, actual MA penetration rates vary widely depending on region. McKinsey found that the 50% figure holds true for urban (or metropolitan) areas, but nonmetropolitan areas lag behind at 41%. McKinsey projects nonmetropolitan areas won’t reach 50% penetration until 2031, presenting opportunities for payers to shore up untapped markets. “Payers will seek to build the networks and capabilities to grow in historically less penetrated markets, such as those with large rural populations,” analysts wrote. Those markets could include entire states — McKinsey noted that CMS’s June data release showed a 59% penetration rate in Michigan, while Wyoming’s was just 13%.

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