Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care.
By James Gutman, Managing Editor
June 27, 2013 Volume 19 Issue 12
With a clear eye partly on the potentially huge market in managing care for Medicare-Medicaid dual eligibles, Magellan Health Services, Inc. this month launched its first full-risk Medicaid managed care plan, Magellan Complete Care. The new unit initially will provide care via an HMO only to beneficiaries in populous Broward County, Fla., and to focus on those with behavioral-health conditions, its president says. But he also tells MAN that the unit is looking to add other counties in Florida later this year and to expand to other states where Magellan also has “a big footprint” in the future.
Magellan is no stranger to Medicaid managed care. Among other stakes, notes Scott Markovich, president of Magellan Complete Care, the company on a non-risk basis has managed both integrated home health services and services for persons with serious mental illness (SMI) in Iowa’s and Arizona’s Medicaid programs. And a larger two-year pilot program will begin in Iowa in July, he says.
However, what Magellan just began in Florida is different because the company is going at full risk and because, unlike what it was going to be doing in Massachusetts’ CMS-backed dual-eligible demonstration slated to begin Oct. 1 as the 49% owner of Fallon Total Care, the firm has no partner. (Later in June, Magellan said it would sell the stake to Fallon because the payment rates in Massachusetts aren’t adequate to offset expected health care costs for the duals there.)
The go-it-alone approach in Florida perhaps shows the attractiveness of both Medicaid managed care opportunities in that state, which on June 14 got final approval from CMS for statewide mandatory managed care, and of other duals opportunities nationwide.
Jacksonville Area Will Be Next Target
Markovich, who had been senior vice president, Medicaid strategy for Magellan before assuming his new role and who was regional vice president for the East region of WellPoint, Inc. before joining Magellan in February 2011, tells MAN that Magellan Complete Care is looking to expand next to the Jacksonville area in 30 to 60 days. It has proposed expansions to other parts of the state as well, but won’t find out if its proposals are accepted for that until the fall, he adds.
The unit also is considering establishing its own Medicaid managed care operations in other states that, like Florida, are looking “for an integrated solution in managing physical and behavioral health,” but he declines to identify them for competitive reasons. Markovich acknowledges that the duals are at the “front” of the targeted populations, as are Medicaid SMI beneficiaries. Duals, he explains, have a high prevalence of behavioral health conditions, and the company’s focus in its duals business will be on managing beneficiaries with those conditions.
This would be in keeping with Magellan’s initial business specialty (the company started as a behavioral health services vendor), although it since has expanded to have major operations in such fields as radiology and specialty-pharmacy management. Magellan has contracted with Medicaid plans, among other customers, to furnish all those services, but Markovich says he doesn’t expect that the company’s new full-risk Medicaid-insurer approach will hurt those relationships.
The company, he asserts, is focusing specifically on a specialty population (i.e., a “high-risk” segment with SMI) within Medicaid and has no interest in managing a general Medicaid population. Markovich stresses that Magellan Complete Care is not looking to compete with the most comprehensive Medicaid managed care plans.
Instead, he says, “we see great opportunities to leverage Magellan’s significant resources and create an entirely new integrated care offering to help states grappling with how to provide quality health care at affordable costs.”
Florida, with more than 3 million Medicaid recipients, clearly is one such state. The new waiver obtained from CMS enables the state to expand a small mandatory managed care demonstration program that began nearly a decade ago. Several plans dropped out of this demo over the years, partly because of payment-rate concerns (MAN 9/2/10, p. 5), and data from it showed only modest savings achieved. But the coming expansion has attracted lots of interest from plans, and one observer says plans now in the state always expected it would attract new entrants.
The observer, who asked not to be identified, points out that the current Florida request for proposals on Medicaid managed care includes some duals business since dual eligibles who don’t need long-term care are considered part of the Supplementary Security Income (SSI) population included in the bids due for submission next month. In fact, he adds, 1.1 million current Medicaid beneficiaries in Florida already chose managed care plans voluntarily, and 25% of them are duals. The new awards for contracts that will begin to be phased in next January will boost this number considerably, of course.
http://aishealth.com/archive/nman062713-04
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