Tuesday, February 24, 2015


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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