MA Flavor of the Week Is Duals

By James Gutman - February 17, 2012

Each year, there seems to be one issue that dominates presentations and questions during Medicare Advantage plan sponsors' quarterly earnings calls. In 2012 so far, this issue clearly is new initiatives to manage care and costs of Medicare-Medicaid dual eligibles. The interest is understandable, of course, since there are 9 million duals and only about 10% of them are in any form of managed care. The only problem is that none of the new state dual-specific initiatives backed by the CMS coordinated care office and the agency's Center for Medicare and Medicaid Innovation even has been chosen yet, so company executives have a challenge in trying to say something specific enough to keep investors' interest.

Different companies have responded to that challenge in different ways. There has been a "remarkable" amount of emphasis on duals in recent months, observed, for instance, Universal American Corp. Chairman and CEO Richard Barasch during that firm's fourth-quarter earnings call Feb. 16. He added that "we know this area is large and important," and the company is poised to pursue it with either capitated or fee-for-service arrangements with providers. "We're excited about the opportunities" for duals and have been preparing for them for "quite some time," said WellCare Health Plans, Inc. CEO Alec Cunningham in his firm's Feb. 15 call. Amerigroup Corp.'s biggest opportunity may "lie ahead with duals" along with long-term care integration initiatives, Chairman and CEO James Carlson said Feb. 17 in that company's call.

Well, you get the idea. But there also were at least a couple of top executives willing to inject a dose of realism into the subject. "We will over time get our share [of duals], but the time frame is unpredictable," said ever-candid Coventry Health Care, Inc. Chairman and CEO Allen Wise in his firm's call Feb. 8. And Aetna Inc. Chairman and CEO Mark Bertolini noted in the firm's earnings call Feb. 1 that the California duals initiative "is not fully laid out, nor is the timing."

Is the duals program creating investor expectations that can't be met?
What is the right mix of enthusiasm and caution that MA — and managed Medicaid — plans should show to it? When the "flavor of the week" is this important, what's the best way to keep it on the menu?