So as not to penalize Medicare Advantage plans serving a large proportion of enrollees with social risk factors (SRFs) that impact care quality, CMS has previously taken steps to adjust for within-contract disparities in Star Ratings performance among MA and Part D contracts. But beginning in 2027, insurers will be rewarded for their efforts to assess SRFs and address disparities in certain quality measures with the new health equity index (HEI). MA and Part D organizations must act now to assess disparities within their contracts' current performance and begin to pinpoint where their efforts can make the biggest impact in the two years of data leading up to the reward, according to industry experts who spoke at AHIP’s 2023 conference.
Hoping to Hasten Crawl to Profitability, Clover Health Inks Outsourcing Deal
Since its inception as a technology-based “disruptor” in the Medicare Advantage space, Clover Health Investments Corp. has struggled to turn a profit. But after showing signs of momentum at the end of 2022, Clover leadership has declared 2023 as a year focused on profitability rather than growth. To speed that path, the insurtech this week unveiled two “business transformation initiatives”: (1) an agreement to transfer its core plan operations to UST HealthProof’s integrated technology platform, and (2) additional corporate restructuring actions that included a recent 10% workforce reduction.
GAO Wants CMS to Enhance Data Collection Efforts Around Supplemental Benefit Use
As expanded supplemental benefits offered by Medicare Advantage plans continue to grow and attract enrollees, a new report from the Government Accountability Office (GAO) observed that there is still limited data on the extent to which beneficiaries are using these benefits. GAO suggested that CMS could do more to collect data on supplemental benefit use from MA organizations and recommended that it issue clarification on current encounter data reporting requirements.
“We’ve heard CMS Administrator Chiquita Brooks-LaSure say at pretty much every recent public appearance that they want to understand where the dollars are going, making sure that they’re getting good value for their investments,” remarks Tim Murray, a principal with the actuarial and consulting firm Wakely Consulting Group, an HMA company. “I think that has some read-through for risk adjustment, which is already playing out, but also of equal importance for the supplemental benefits. And I think if Medicare Advantage as an industry is going to be able to make a data-driven case that these supplemental benefits are actually driving sustainable value for members beyond marketing sizzle, then this issue will need to be addressed and remedied.”
CVS-Oak Street Deal Could Boost Aetna MA Retention, but Faces Regulatory Risks
Confirming a tie-up that had been rumored for months, CVS Health Corp. on Feb. 8 revealed that it struck a $10.6 billion deal to buy Oak Street Health, which owns primary care centers catering to Medicare-eligible patients. Executives of the two firms say the benefits of the proposed transaction abound for both CVS Health and Oak Street — including having the potential to help CVS Health-owned Aetna retain Medicare Advantage members — but industry observers say the acquiring firm still faces a bevy of risks as it seeks to incorporate multiple new care delivery assets.
During CVS Health’s conference call to discuss fourth-quarter and full-year 2022 financial results, CEO Karen Lynch and Mike Pykosz, Oak Street’s president, discussed the merits of the deal at length.
Seniors’ Plan Loyalty Wavers as Deft Saw 15% Medicare Advantage Switch Rate in 2023 AEP
Each year, Deft Research surveys a panel of Medicare beneficiaries to better understand consumer decision making during the Medicare Annual Election Period (AEP) and help carriers and their partners strategize for the next plan year. Deft’s 2023 Medicare Shopping and Switching Study, the latest in the firm’s Senior Market Insights Service series, features responses from more than 3,000 seniors who were surveyed immediately after the AEP and an additional 1,800 individuals who were surveyed regularly during the October-December period.
While the overall switching rate among seniors shopping during the AEP was relatively unchanged from prior years at 11%, Deft observed that switching by Medicare Advantage beneficiaries reached 15%, up from 12% seen in the prior two periods. That wasn’t surprising given that Deft’s AEP Gut Check Study from July 2022 suggested seniors’ frustration with plan-offered flex cards and interest in Part B giveback benefits might inspire them to shop around.
2023 Outlook: MAOs Mull How to Compete While They Brace for Change, Uncertainty
In a sweeping proposed rule for the 2024 contract year, CMS last month took a strong stance on multiple aspects of the Medicare Advantage program, from misleading marketing and prior authorization to quality gains incentivized by the Star Ratings. As plans digest the many changes proposed in that rule, several major unknowns remain that could impact their revenue streams and ability to compete going forward. For our annual series of outlook stories on the year ahead, we asked a range of industry experts to weigh in on how doing business in 2023 might differ from previous years. Here’s the first installment on industry challenges and trends as told to AIS Health, a division of MMIT.
2023 Outlook: Plans Prepare for Pending Wave of Changes to Star Ratings
When it comes to chasing high ratings and quality bonus payments to help them stay competitive, Medicare Advantage and Part D plan sponsors this year may be forced to overhaul their current strategies and investments if CMS finalizes a host of recently proposed changes. In addition to implementing a new outlier methodology that will drive up cut points and make it harder for plans to achieve 4 stars next fall, CMS last month issued a sweeping rule proposing policy and technical changes across the MA and Part D programs for contract year 2024. That rule included multiple proposals aimed directly at the stars program, such as the creation of a health equity index for the 2027 Star Ratings and the addition of several new measures to the 2026 Star Ratings.
Sweeping MA, Part D Proposed Rule Touches on Everything From Stars to SNPs
Exceeding 950 pages in its initial prepublication version, CMS’s most recent rule proposing policy and technical changes for contract year 2024 is the Biden administration’s most complicated and sweeping Medicare Advantage and Part D rule to date. Following a comprehensive request for information issued last summer on various aspects of the MA program, the rule addressed many of the same hot-button topics — from health equity and misleading marketing to behavioral health and prior authorization — that CMS asked about in the RFI. Additionally, the rule proposed major reforms to the Star Ratings and contained meaningful clarifications for MA Special Needs Plans (SNPs).
MedPAC Mulls Concept of Standardizing Common Supplemental Benefits in MA
As Medicare Advantage insurers continue to grow their supplemental benefits offerings and CMS maintains a focus on improving the consumer experience, the Medicare Payment Advisory Commission (MedPAC) has begun work on the nascent concept of standardizing certain benefits in MA. During its Nov. 4 public meeting, the commission seemed mostly interested in standardizing a limited number of common supplemental benefits in the name of helping beneficiaries make better plan comparisons, but several commissioners expressed concern about potentially hampering MA plan innovation.
Top Stars Performers Credit Careful Messaging, Provider Collaboration
As CMS resumed normal Star Ratings calculations and gave greater weight to patient experience measures for 2023, the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning 4 stars or higher saw a dramatic drop from 2022, according to newly released CMS data. In Part 2 of an AIS Health series on successful Star Ratings strategies, top performers say maintaining a company-wide focus on quality and member experience is key to their approach. And while member outreach is a critical part of those initiatives, successful plans are careful to avoid overcommunicating with members and creating message fatigue, sources tell AIS Health, a division of MMIT.