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
July 30, 2015 Volume
21 Issue 15
Why isn’t enrollment in programs for
Medicare-Medicaid dual eligibles growing as quickly as expected? A big reason,
said some health plan executives in the initial batch of second-quarter
earnings calls with investors this month, is many physicians don’t want and are
seeking to discourage the programs. The plans’ comments made more public
sentiments that had been expressed in a subdued fashion by several state and
insurer officials in prior quarters.
“The challenge in all of these [i.e.,
duals] markets is that there is a very low rate of physician acceptance,” said,
for instance, Barry Smith, chairman and CEO of Magellan Health, Inc., during
that company’s July 27 earnings call. Smith added that he doesn’t expect to see
“a great change” in physician acceptance, despite the efforts of Magellan and
other duals-plan sponsors to show those providers the benefits for them, so it
is developing “strategic risk contracting relationships with large provider
organizations” in an attempt to deal with this. But for now, he indicated, the
lack of provider support has translated into many duals not seeing “a clear
benefit” for staying in a duals plan in which they’re passively enrolled.
Similarly, when asked about the lack of
major duals-plan enrollment progress in Centene Corp.’s July 28 earnings call,
Chief Financial Officer William Scheffel said, “One of the biggest drivers of
it is the attitude of the provider community about moving people into managed
care programs versus fee-for-service Medicare.”
Centene Chairman and CEO Michael
Neidorff elaborated on this in response to a question about which types of
providers are encouraging their duals patients to opt out of the CMS-backed
demo in the four states (Michigan, Ohio, South Carolina and Texas) it serves in
that program. He indicated all of the kinds of providers the questioner asked
about — nursing homes, home health and post-acute care — were “at different
times providing that pressure.”
But Centene is trying hard to make the
duals demo “easier and less complicated” for them, he stressed, with the aid of
medical management systems and is making a little headway. Ohio, for instance,
has an opt-out rate for the company’s duals plan of “30% to 32%,” he said,
which would make it well below opt-out rates being reported in some other
states, and “it is coming down a bit.” Centene now has a total of about 19,700
duals enrollees in the four states after opt-outs are subtracted, he added.
Magellan has only “relatively modest”
membership in the duals product sponsored by its AlphaCare managed long-term
care (MLTC) plan in New York’s delayed Fully Integrated Duals Advantage (FIDA)
demo that began in January, reported Smith. He explained that AlphaCare has
about 3,200 members in all its product lines, with 1,900 of them in the
Medicaid MLTC product that FIDA attempts to build on.
Even with the “initial lack of
acceptance of FIDA,” he asserted, AlphaCare’s other products (i.e., MLTC,
Medicare Advantage and MA dual-eligible Special Needs Plans) “can still be very
successful.” The keys, he said, are for AlphaCare to develop “incremental
contracts” with licensed home care and other agencies and to increase the
number of “distribution channels” for the MLTC product.
He explained that most MLTC providers
in New York “have not been excited about moving to FIDA because they don’t want
the incremental expenses of the Medicare overhead and compliance structure
required for the FIDA program.” These providers are “politically very strong,”
said Smith, and “my sense is that’s true across the country,” so there’s no
likelihood of a program like FIDA being made mandatory.
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