Medicare Advantage |

How Medicare Advantage Plans Can Increase Consumer Satisfaction

August 18, 2016 By Jay Baldauf

Medicare Advantage plans are more likely to achieve high satisfaction scores when they offer a consistent product message and brand experience and have control over the delivery of care, according to a J.D. Power study. Members frequently choose a plan they understand and find easy to work with. The study measures member satisfaction with Medicare Advantage plans based on six factors in order of importance: coverage and benefits (26%); customer service (20%); provider choice (15%); cost (14%); information and communication (13%); and claims processing (13%).

Improving communications with enrollees is one of the greatest opportunities for health plans to improve member satisfaction. It’s the only factor in the study that has not seen a significant improvement in member satisfaction. Valerie Monet, director of the insurance practice at J.D. Power, said that many plans have multiple product design features and come with technical manuals that are 20 pages or longer. Expecting members to be experts on these services and benefits is a losing battle for the plan and the member. Members expect their plan to provide guidance, ranging from assistance in selecting a doctor to helping them understand prescription costs.

Forty-eight percent of members agree strongly that their health plan is a trusted partner in their health and wellness, which increases satisfaction by 166 points. Satisfaction is 136 points higher among the 89% of members who completely understand how to find a doctor under the plan. Satisfaction is 110 points higher among the 88% of members who say their doctor spends the right amount of time with them.

Members expect immediate attention or advice when they call their health plan provider. Forty-one percent of those who called their plan had to give the same information more than once to get their issue resolved. Only 35% of members said that customer service provided all of the information they needed on the costs of prescription medications. Ninety-one percent of customers who are delighted with their Medicare Advantage plan (satisfaction scores of 901 or higher), say they will definitely renew their policy, and 89% will definitely recommend their plan to family and friends. Loyalty drops to 71% and advocacy to 66% among members who are pleased with their plan (scores of 751-900). Plans garnered the following member-satisfaction scores:

Kaiser Permanente 851
Highmark 791
Humana 782
UnitedHealthcare 775
Cigna 774
Aetna 773
Anthem 765
Health Net 756
WellCare 742

In 2016, members reported an average increase of $117 in annual premiums to $1,497. They also have more out-of-pocket expenses. On average, member deductibles are $1,705 in 2016, a $310 jump from 2015. Satisfaction is 136 points higher when members completely understand their out-of-pocket costs. Monet said that members are more satisfied and see the value of their plan when they have a better understanding of how much they are paying and what the costs cover.” For more information visit http://www.jdpower.com/resource/us-medicare-advantage-study.

Filed Under: Doctors, Drugs, Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: Benefits, Claims processing, communications, consumer, Cost, coverage, enrollees, health plans, increase, JD Power, MAPD, Medicare, Medicare Advantage, provider choice, satisfaction, study

HMOs Beat PPOs on Cost and Quality

August 4, 2016 By Jay Baldauf

California’s commercial HMOs outperform commercial PPOs on most clinical quality measures. They also consistently provide less costly care. The average yearly cost is $4,245 per HMO enrollee versus $4,455 per PPO enrollee, according to the California Regional Health Care Cost & Quality Atlas. The report comes from the Integrated Healthcare Assn., the California Health Care Foundation, and the California Health and Human Services Agency. Differences in benefit designs don’t explain the cost variation since the total cost of care includes enrollee cost-sharing (deductibles and coinsurance) as well as insurance payments to providers.

HMOs may be performing better because they rely on integrated care networks, which generally accept capitation (fixed per-member, per-month payments). So they are accountable for the patients’ health and are generally rewarded for it, according to the report. So why is HMO enrollment declining? PPOs are often less costly for employers since they reduce premiums with higher enrollee cost-sharing, such as deductibles and coinsurance. But employers should look at the whole picture since HMOs produce superior results when you consider quality and the total cost of care, according to the report.

Quality of Care
California’s commercial HMOs perform better than their national counterparts on every clinical quality measure except asthma medication management. At the same time, California’s commercial PPOs perform worse than the national average on five of the six measures.

When Kaiser Permanente is removed from the analysis, the difference in clinical quality between HMOs and PPOs is cut by about half. Also, the performance difference on risk-adjusted total cost of care narrows substantially, but HMOs still outperform PPOs.

Quality is highest in Northern California, solid in Southern California, and weakest in Central California. The study reveals these regional differences is quality:

Northern California outperforms Central and Southern California on clinical quality.
Central California falls below the statewide average on key clinical measures for cancer, diabetes, and asthma.
The lowest performing region is the Eastern region 13, which includes Central California counties Mono, Inyo, and Imperial.
The highest performing region is Contra Costa County region in Northern California.
Clinical quality scores vary significantly on some measures. For example, 33% of commercial enrollees with diabetes in Alameda County region six have poorly controlled blood sugar, compared to 75% in the Eastern region 13.
In Southern California, San Diego County region 19 is the highest performing region, outperforming Northern California regions: San Mateo County region eight and San Francisco County region four.

If all commercially insured Californians got the same quality of care as top-performing regions, nearly 200,000 more people would have been screened for colorectal cancer and 50,000 more women would have been screened for breast cancer in 2013. If care is provided to all Californians at the same cost as in San Diego, the cost of care would decrease 10% for commercially enrolled people. Many factors contribute to regional performance, including socioeconomic characteristics and the availability of medical services.

Medicare Advantage
The quality and cost of care varies widely for seniors enrolled in Medicare Advantage. For example, in North Bay counties, 91% of women have gotten appropriate breast cancer screening compared to 70% in the Eastern region 13. The average annual per-enrollee total cost of care for Medicare Advantage enrollees ranges from $11,500 in San Diego County to $14,500 a year in Los Angeles region.

Cost of Care
Geographic variation in cost of care is dramatic—a difference of $1,800 in the average annual per-enrollee total cost of care between the most costly and least costly regions. With one exception, all Northern California regions have higher annual per-enrollee costs than the statewide commercial average of $4,300 while all Southern California regions fall below the statewide average. Central California regions show mixed results on cost. HMOs have a lower average total cost of care than do PPOs in 12 of the 18 regions. More tightly managed care in HMOs may contribute to a lower cost of care. Yet, inpatient bed days and readmission rates are similar for HMOs and PPOs. Emergency department visit rates are actually higher for HMOs. The statewide average annual per-enrollee cost of care for commercially insured Californians is $4,300. Kern County is the least costly HMO region. It’s $1,800 per enrollee, per year less than in Santa Clara County, which is the costliest HMO region. The least costly PPO region is Los Angeles at $2,400 less than San Francisco County, which is the costliest PPO region.

Filed Under: Doctors, Drugs, Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: ACA, California, CMS, Cost, cost of care, Drugs, HHS, HMOs, MAPD, Medicare Advantage, obamacare, Part D, PPOs, quality, Quality of care

H.R.5659 Would Open Medicare Advantage to End-Stage Renal Patients

July 15, 2016 By Jay Baldauf

Dialysis Patient Citizens (DPC) hailed the introduction of H.R. 5659 as the latest milestone toward opening Medicare Advantage enrollment to end-stage renal disease (ESRD) patients. Stephen Anderson, a patient advocate from Indianapolis said, “As a dialysis patient of five years, I am fortunate to have secondary insurance to cover what Medicare does not. However, I know many patients in my facility don’t have that luxury. Providing dialysis patients access to Medicare Advantage will greatly help to reduce our out-of-pocket costs while improving our health with care coordination measures,” said. A study comparing outcomes of dialysis patients grandfathered into Medicare Advantage plans found that they have lower mortality rates than id their peers in fee-for-service plans. For more information, visit dialysispatients.org.

Filed Under: Diabetes, Doctors, Drugs, Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: Bill, congress, DRC, end stage renal Patients, ESRD, MAPD, Medicare Advantage, open, patients

Medicare Advantage 2016 Spotlight

May 28, 2016 By Jay Baldauf

The number of Medicare beneficiaries enrolled in Medicare Advantage has climbed steadily over the past decade; this trend in enrollment growth continues in 2016. The enrollment growth has occurred despite provisions under the ACA that reduce payments to plans. As of 2016, the payment reductions have been phased in fully in 78% of counties, accounting for 70% of beneficiaries and 68% of Medicare Advantage enrollees, according to a study by the Kaiser Family Foundation. The following are study highlights:

Medicare Advantage enrollment has increased in virtually all states over the past year. Almost one in three people on Medicare (31% or 17.6 million beneficiaries) is enrolled in a Medicare Advantage plan in 2016. The penetration rate exceeds 40% in five states.
18% of enrollees are in a group plan. Employers and their retirees still favor local PPOs over HMOs.
Enrollment is still highly concentrated. If Aetna acquired Humana with no divestitures in 2016, the combined firm would account for 25% of Medicare Advantage enrollees nationwide. UnitedHealthcare and Humana account for 39% of enrollment in 2016.
Premiums were relatively constant from 2015 to 2016 ($37 a month in 2016 versus $38 a month in 2015), although premiums vary widely across states, counties, and plan types.
In 2016, the average enrollee had an out-of-pocket limit of $5,223, which is nearly $1,000 higher than in 2011.
31% of the Medicare population is enrolled in a Medicare Advantage plan. Total Medicare Advantage enrollment grew 5%, from 2015 to 2016. This reflects the influence of seniors aging on to Medicare and beneficiaries shifting from traditional Medicare to Medicare Advantage.
64% of Medicare Advantage enrollees are in HMOs; 23% are in local PPOs; 7% are in regional PPOs; 1% are in private fee-for-service plans; and 4% are in other types of plans including cost plans and Medicare medical savings accounts.
Enrollment in private fee-for-service plans has declined slowly since the Medicare Improvements for Patients & Providers Act (MIPPA) of 2008. Under the law, in most parts of the country, private fee-for-service plans must have a provider network. About 1% of Medicare Advantage enrollees are in these plans. 26% of enrollees in private fee-for-service plans are in counties in which private fee-for-service plans are exempt from network requirements.

Medicare Advantage enrollment in California grew 6% from 2015 to 2016.
44% of beneficiaries in Los Angeles County, California are enrolled in Medicare Advantage plans compared to only 11% of beneficiaries in Santa Cruz County, California.

The average MA prescription drug enrollee pays a monthly premium of about $37, which is 1% less than in 2015. Actual premiums are $28 a month for HMOs, $63 a month for local PPOs, and $76 a month for private fee-for-service plans. Average Medicare Advantage premiums for HMOs and local PPOs have decreased since the ACA was enacted while average premiums have increased for regional PPOs and private fee-for-service plans.

In 2016, 81% of Medicare beneficiaries had a choice of at least one zero premium MA prescription drug plan. From 2015 to 2016, the share of enrollees in zero premium MA prescription drug benefits remained relatively unchanged (48% in 2015 versus 49% in 2016). Fifty-nine percent of HMO enrollees are in zero premium plans; 38% are in regional PPOs; and 22% are in local PPOs. No zero premium private fee-for-service plans plans were offered in 2015 or 2016.
The average out-of-pocket limit for a MA prescription drug enrollee is $5,223, up from $5,041 in 2015 and $4,313 in 2011. The share of enrollees in plans with limits above $5,000 has greatly increased across all plan types. Fifty-two percent of enrollees are in plans with limits above $5,000 in 2016 compared to 46% in 2015. Thirty-seven percent of enrollees in 2016 are in plans with limits at the $6,700 maximum, compared to 32% in 2015 and 17% in 2011. Ninety-nine percent of regional PPO enrollees and 62% of local PPO enrollees are in plans with limits above $5,000 in 2016. In comparison, 45% of HMO enrollees are in plans with limits above $5,000 in 2016.
The standard Medicare Part D plan has a $360 drug deductible and 25% coinsurance up to an initial coverage limit of $3,310. That is followed by a coverage gap (the doughnut hole) in which beneficiaries pay a larger share until their total out-of-pocket Part D spending reaches $4,850. After exceeding this catastrophic threshold, beneficiaries pay 5% of the cost of drugs.
95% of Kaiser Permanente’s enrollees are in HMOs. In contrast, enrollment in UnitedHealthcare and Humana plans is mostly in HMOs, but includes significant shares in local and regional PPOs. Humana’s distribution continues the shift from earlier years when a much larger share of Humana’s enrollees was in private fee-for-service plans plans. Enrollment in BCBS plans is split between HMOs (46%) and local PPOs (41%), with the remainder in regional PPOs and other plan types including private fee-for-service plans plans.
Kaiser Permanente’s presence is more geographically focused than other major national employers, with a heavy concentration in California, Colorado, the District of Columbia and Maryland.
Medicare Advantage enrollment could become more concentrated if Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna are approved, particularly if few divestitures are required. If no divestitures are required in Aetna’s acquisition of Humana, the combined company would account for 25% of Medicare Advantage enrollment nationwide. UnitedHealthcare accounts for 21% of enrollment this year.
The Anthem’s acquisition of Cigna would have a less visible affect on the national Medicare Advantage market. Nationwide, Anthem accounts for 3% of Medicare Advantage enrollment and Cigna accounts for another 3%.
For many years, CMS has posted quality ratings for Medicare Advantage plans. In 2016, 68% of plans had four or more stars. In focus groups, seniors have said that they don’t use the star ratings to select a plan. Nonetheless, the star ratings may be correlated with factors that seniors do use to select their plan, including provider networks, and plan benefits and costs, and thus may be correlated with enrollment.
The Congressional Budget Office projects that about 41% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2026. This growth may prompt some to question what it will mean if the preponderance of beneficiaries are in Medicare Advantage plans.

Filed Under: Doctors, Drugs, Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: ACA, acquisitions, aetna, anthem, Blue Shield, California, cigna, CMS, enrollees, HHS, HMOs, Humana, Kaiser, MA, MAPD, Medicare, Medicare Advantage, MIPPA, Part D plans, PPOs, Premiums, prescription drugs, spotlight, UHC

Medicare Advantage Versus Traditional Medicare

April 24, 2016 By Jay Baldauf

A report by the Kaiser Family Foundation reveals that Medicare HMOs perform better than traditional Medicare in providing preventive services and using resources more conservatively, at least through 2009. Two studies found that Medicare PPOs performed better than traditional Medicare on some metrics (particularly mammography rates). HMOs performed better than PPOs. These studies were conducted before changes made by the Affordable Care Act (ACA) to improve coverage of preventive services under traditional Medicare.

There is some evidence that relatively low cost-sharing (through Medicare HMOs or through Medicare with supplemental coverage), may result in earlier diagnoses of some cancers compared to traditional Medicare alone. Treatment patterns for some cancers may differ between Medicare HMOs and traditional Medicare, but studies do not show that it affects patient outcomes.

Medicare beneficiaries in HMOs are less likely to be hospitalized for a potentially avoidable admission than beneficiaries in traditional Medicare, according to six studies of beneficiaries represented by the Alliance of Community Health Plans (ACHP). Four of these studies rely on data before 2006, and reflect HMO experiences in mature markets. Performance varies substantially among Medicare Advantage plans, even among those of the same plan type. More established HMOs with integrated delivery systems tend to perform better.

On the other hand, beneficiaries rate traditional Medicare higher in quality and access, such as care and plan rating, though one study suggests that the difference may be narrowing for the average beneficiary. Traditional Medicare is much more popular among beneficiaries who are sick. It is not yet possible to assess performance after the implementation of the ACA’s Medicare Advantage payment changes. Except for hospice care, none of the 40 studies comparing Medicare Advantage to traditional Medicare rely on data from 2010 or later

Filed Under: Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: ACA, ACHP, CMS, HHS, HMOs, kaiser foundation, MAPD, Medicare, Medicare Advantage, PPOs, traditional Medicrae, versus

Groups Says that Divestitures Don’t Keep Medicare Advantage Competitive

March 25, 2016 By Jay Baldauf

Requiring companies to divest does not maintain competition amid health insurance mergers, according to an issue brief by the Center for American Progress. (Competition authorities frequently require merging parties to divest a number of brands or operations in order to clear a proposed merger.) The Center says that divestitures don’t restore competition with Medicare Advantage plans. Also, seniors pay higher premiums for divested plans. By 2015, acquiring partners exited more than half of the affected counties. Only two of the 15 divested plans are offered, and premiums increased an average of 44% for more than half of the divested plans. Researchers at the Center say that divestitures in the proposed Aetna-Humana merger won’t be successful in maintaining competition and protecting seniors. In fact, the proposed Aetna-Humana merger would greatly reduce market competition for Medicare Advantage beneficiaries. In markets where Medicare Advantage beneficiaries have a choice of insurers, Aetna’s average annual premiums were lowered by as much as $302 and Humana’s annual premiums were lowered by as much as $43. Under the merger, premiums could increase beyond these amounts because of the greater market power of the combined company.

Filed Under: Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: aetna, aquiring partners, Center for American Progress, competition, Divestures, Humana, issue brief, Medicare, Medicare Advantage, mergers, plans, requiring carriers, seniors

Analysis Underscores the Need for ‘Any Willing Pharmacy’ Policy in Part D

February 18, 2016 By Jay Baldauf

National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA issued the following statement in response to the detailed preferred pharmacy access analysis released by the Centers for Medicare & Medicaid Services (CMS) and conducted in response to concerns raised by NCPA, beneficiary advocates and others:

We appreciate Medicare officials acting on the concerns that NCPA members, beneficiaries, patient advocacy organizations and members of Congress have raised. We are still reviewing the full CMS analysis. Our initial reaction is that more work must be done in this area. The CMS analysis documents progress yet still identifies many plans that are ‘access outliers’ that impact a significant number of beneficiaries. Indeed, this total could be higher because CMS excluded from this analysis plans granted waivers to the retail pharmacy convenient access standard requirement. The marketing disclaimers, while appreciated, come well after the 2016 enrollment period concluded and six weeks into the plan year.

In addition, the format in which this data has been posted should be more accessible to the average Medicare beneficiary or their caregiver. Information of this importance should be incorporated into Medicare Plan Finder prominently – and before beneficiaries research their enrollment decisions.

Beneficiaries need swifter relief and protection. To that end, we encourage Medicare officials to implement an ‘any willing pharmacy’ policy and Congress to enact H.R. 793 / S. 1190. This would allow beneficiaries in medically under-served areas to access their prescription drugs at a community pharmacy that accepts the drug plan’s terms and conditions and can serve those patients. Medicare officials have already acknowledged that this is ‘the best way to encourage price competition and lower costs in the Part D program.

Filed Under: Drugs, Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: analysis, any willing pharmacy, CMS, drug coverage, Medicare, Medicare Advantage, ncpa, need, Part D, PDP, underscores

CMS Undermines Medicare Advantage Chronic Care

February 1, 2016 By Jay Baldauf

CMS underestimates costs for people with multiple chronic conditions to the tune of $2.6 billion annually, according to a study by Avalere. In the spring of 2015, CMS finalized changes to the risk adjustment system, targeting chronic disease prevention programs. These changes significantly limit health plans’ early intervention efforts and seniors’ benefits. Under the risk adjustment model, CMS substantially under-predicts expenditures for providing care to beneficiaries, including those with the following conditions:

Chronic kidney disease.
Osteoarthritis.
Rheumatoid arthritis.
Alzheimer’s disease and related conditions.

AHIP president and CEO Marilyn Tavenner said, “Further cuts to Medicare Advantage and seniors’ benefits are…at odds with…delivering better care and better value for beneficiaries. Rather than relying on an antiquated fee-for-service approach…, CMS should focus on strengthening Medicare Advantage and the innovative programs that improve seniors’ health.”

Last year, more than 340 members of Congress urged CMS to protect seniors’ coverage and provide stability to the program. Ahead of the upcoming February rate notice, more than 2 million seniors from AHIP’s Coalition for Medicare Choices have mobilized, urging Washington to defend the Medicare Advantage program from further payment cuts

Filed Under: Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: Ahip, Avalere, Chronic Care, CMS, costs, MAPD, Medicare Advantage, multiple conditions, SNP, study, underestimates, Undermines

Top Challenges for People with Medicare

January 24, 2016 By Jay Baldauf

The Medicare Rights Center released its annual report based on thousands of calls to its national helpline. Two trends stood out among the questions from helpline callers:

Navigating Medicare Part B Enrollment: Many people are confused by Medicare enrollment rules, and specifically whether to take or decline Part B, which covers doctors’ and other services. Some have other coverage through an employer or the new state or federal Marketplace and want to know how insurance may change because they are eligible for Medicare. While callers may be aware of the risk of late enrollment penalties, they may not realize that their former insurance may refuse to pay for care once they are Medicare-eligible.
Navigating Part D Prescription Drug Appeals: In addition to not knowing why their prescription drug was denied, callers are confused by the Part D appeals process. They are often unsure about whether their appeal has been filed, what level of appeal they are in, and what their doctors have done on their behalf.

Drawing from Medicare Rights’ 25 years of experience serving people with Medicare and their families, the report includes a comprehensive set of policy recommendations on how to improve access to affordable health coverage. Among the recommendations are to provide better education to newly eligible beneficiaries about Part B enrollment and prescription-drug appeals and streamline enrollment periods for employers.

Filed Under: Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: appeals, marketplace, Medicare, Medicare Advantage, Medicare rights center, Part B enrollment, Part D, prescription drugs, supplements, Top challenges

Consumers Like Their Med Advantage Plans

October 31, 2015 By Jay Baldauf

Nearly half of Medicare Advantage members agree strongly that their health plan is a trusted partner in their health and wellness, according to a J.D. Power survey. Sixty-four percent say they have enough coverage for the care they need. Rick Johnson, director of the Healthcare Practice at J.D. Power said, “Medicare Advantage health plan members tend to have a more favorable image of their health plan than do members of commercial plans on brand measures of trustworthiness, affordability, reputation, and customer-centricity. Members pay more to move from Medicare to Medicare Advantage. The plans and the government do an excellent job demonstrating the value of the Medicare Advantage plan. Members say the money spent is worth it.”

One of the key benefits Medicare Advantage plans offer is the choice of primary care doctors, specialty doctors, and hospitals. Seventy-three percent of members say their doctors have not been dropped from their plan’s network during the past year, and 74% say that their hospitals have not been dropped

Filed Under: Employer Benefits, General Health, Medi-Cal, Medicare, Men's Health, Reform, retirement, Senior Health, Wellness, Women's Health Tagged With: Consumers, J.D. Power, Like, MAPD, Medicare Advantage, nearly half, plans, Survey