THE 'EDGE REPORT BLOG

Three Takeaways from the Medicare Advantage Leadership Innovations Conference

150 health plan executives, industry experts and vendors gathered in Phoenix, Arizona over two days April 10 and 11th to share experiences and ideas for successfully navigating the Medicare Advantage landscape.  Here are three compelling takeaways from the stimulating discussions.

Medicare Advantage is a Growing and Lucrative Opportunity
Medicare Advantage enrollment is projected to grow from 21 million individuals this year to 38 million members in 2025.  The Medicare Advantage (MA) population presently makes up 33% of the total Medicare enrollment and  is expected to rise to 40% by 2025, according to the Kaiser Family Foundation.  This represents a burgeoning market opportunity, one with sophisticated consumers who have great expectations from their health plan.  According to John Gorman, the Executive Chairman of Gorman Group, a firm that provides consulting services to Medicare and Medicaid health plans, MA is the safest bet in healthcare.  Gorman pointed to the recent Final Call Letter for 2019 from CMS, which called for a 6.4% increase in revenue for Medicare Advantage plans.

Quality and Consumer Satisfaction Will Be a Major Criteria for Success Among Health Plans
Twenty states are making decisions regarding which health plans to work with in Medicaid programs based on those plans’ Medicare Star ratings.  This is an unprecedented move and an indication of the importance of measurable quality results. Health plans with solid Star ratings, high member satisfaction and demonstrable quality metrics will be successful.  Many presenters acknowledged that achieving high Star ratings takes cross-functional commitment across the organization.  For example, a very small number of consumer complaints can materially impact a plan’s Star rating. In 2017, 37 plans had their rating lowered, 21 plans gained in their ratings. It is not just states that are focused on quality – new enrollees are too. Fifty percent of Baby Boomers will choose Medicare Advantage within two years of entering Medicare, making decisions based on their prior health insurance experience.  Today,  Aetna boasts that 73% of their Medicare Advantage members are enrolled in a PPO plan, which closely mimics what many Baby Boomers are used to getting from former employers.  And a recent Deft Research study was cited which reported that the single biggest criteria for member satisfaction was being well informed by one’s health plan.  Members who understood their benefits and could obtain clear explanations of their financial responsibility and provider network consistently registered higher satisfaction than those who had trouble getting the same information.

Care is Being Delivered Differently, and Will be Reimbursed Differently
A recent rule provided by the Centers for Medicare and Medicaid (CMS) is changing the categories of products and services to be reimbursed as primarily “health-related” benefits under Medicare Advantage.  CMS said the insurers will be permitted to provide care and devices that prevent or treat illness or injuries, compensate for physical impairments, address the psychological effects of illness or injuries, or reduce emergency medical care. For the first time, things such as air conditioners for asthmatics, grab bars in bathrooms and even groceries to remedy food insecurity will be eligible for reimbursement.  This rule recognizes that to bring the cost of healthcare down, the whole person must be considered, including root causes of chronic conditions and not just their symptoms. 

There were several vigorous debates among conference attendees about the relative merits and growing popularity of telehealth.  Clinicians voiced hesitation at the non-traditional method of diagnosis and care, and see it as a supplement to high-touch medicine, not as a substitute.  Studies report that younger demographics are more receptive to telehealth.  There was alignment around the idea that telehealth promotes access to care for remote patients, both in rural and inner-city settings.  The amount being reimbursed by Medicare Advantage for telehealth is relatively low – in the tens of millions of dollars and is sure to rise sharply in future years.

Many current issues facing Medicare Advantage health plans were raised at the conference and although all agreed that the future is bright for MA, there was healthy debate regarding what that future will look like.

Subscribe to the 'Edge Report Blog