Opportunities for managed
care plans abound in Medicare Advantage (MA), the popular, competitive program
that seems to enjoy bipartisan support, experts tell AIS Health.
The bottom line is,
"The [MA] payment rate seems OK, and there will be a lot of innovation,
heavy advertising, more vertical integration," says Stephen Wood, managing
partner at Clear View Solutions, LLC. "It's still a very robust market…and
the Medicare population is growing by leaps and bounds."
Wood, along with his
partner, Kirk Twiss, describes the MA environment as "market consolidation
at the top — with some states virtually dominated by two or three carriers, a
few 'ankle biters,' and that's it — and fragmentation, growth and
specialization at the bottom."
The latter includes local
provider-sponsored startups trying to launch specialized MA products, he says.
But he notes that such startups face fundamental challenges: gaining sufficient
enrollment and having enough revenue to cover administrative expenses.
Moreover, Twiss points out, it's "hard to compete against national plans
with so many resources."
On the Medicare Part D
side, much remains in play, Twiss notes. Due to industry consolidation and
vertical integration, there won't be independent PBMs, he says, and issues
surrounding prescription drug rebates, Part D benefit design and drug pricing
are all unresolved.
With MA bids for next
year due in early June, Brad Piper, principal and consulting actuary for
Milliman, Inc., says "In my mind, flexibility was probably one of the key drivers
[of MA] in 2019, and I think we're going to see that still in 2020."
The MA program, by
including more flexibility on supplemental benefits, is allowing what Piper
calls "enticement" benefits. In addition to fitness, dental, hearing
and vision benefits, plans increasingly are offering a benefit to help members
purchase over-the-counter health-related items, he says, and transportation to
the doctor's office is becoming more popular.
Wood describes them as
"sizzle" benefits that are "more marketing oriented than
clinically oriented." He says companies continue to assess how to deliver
such benefits and develop solid 2020 bids containing them by the June deadline.
What does the future hold
for MA? "At least for the next year, it's all good news," Twiss says.
"Beyond that, things change very quickly in the health care business."
From Health Plan Weekly
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