Playing the Numbers: Interpreting CMS’s
Enrollment Data Is Exhausting, Revealing
By James
Gutman - February 18, 2015
The full picture of how the 2015 Annual
Election Period (AEP) was for Medicare Advantage (MA) plans finally emerged
Feb. 11 when CMS posted the February enrollment data, and the answers in two
words are “good” and “perplexing.”
The “good” stems from an approximately
342,000 gain in MA membership between CMS’s January and February data. That
came on top of a 133,000 rise between last December and this January to bring
the total to 475,000, a solid 3% gain albeit smaller than the 546,000 or 5.5%
in the 2014 AEP. The difference from a year ago is logical, suggests consultant
Eric Hammelman, a vice president at Avalere Health, LLC, when one considers
that benefits in many MA plans are less “robust” for 2015, as plans responded
to reduced payment rates from CMS by trimming benefits or raising copayments.
The “perplexing” relates not to the
agency’s somewhat contra-intuitive two-step MA reporting — with the January
data including all but the last three days of the AEP — since plans and
analysts now are used to not reading too much into the January results. Instead
it relates to some of the individual company and product results that don’t
seem to make sense until you look at the underlying developments contributing
to them.
Anthem, Inc., for instance, Hammelman
notes, is down substantially in MA enrollment from the year-ago level, but up a
healthy 5% in individual markets where it remained. The insurer had numerous
service-area exits and lost a big employer account but fared well in the MA AEP
otherwise. UnitedHealth Group is an example in the reverse direction. Its
enrollment figures look pretty good because it picked up a couple of large
employer pacts, but United was down for the second straight year in the
individual MA market because of service-area pullouts, points out Hammelman.
And then there are the strange-seeming
data showing that recent years’ hot MA product Special Needs Plans (SNPs)
actually had nearly 90,000 fewer members on the Feb. 1 payment date, reflecting
enrollments accepted through Jan. 9, than it did for the Dec. 1, 2014, payment
date. Here there appear to be two culprits: the move of SNP members to the new
CMS-backed demonstrations for Medicare-Medicaid dual eligibles and the exits of
some lower-star-rated SNPs because they can’t garner enough revenues to cover
their costs.
What do you think are the biggest
takeaways from the February MA data other than that “there are lies, damn lies
and statistics”? Are CMS star ratings now going to be the biggest determinants
of which MA plans live and die? Was 2014 the last big year for MA growth
because, even with the continuing help from large numbers of Medicare age-ins,
plans are deciding some geographic markets no longer make sense for these
products? And are the days of SNPs numbered if they don’t get stars relief?
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