Radar on Medicare Advantage

In recent years, publicly traded managed care organizations have jumped on a growing corporate trend of publishing annual environmental, social and governance (ESG) reports designed to spotlight the larger impact their company is having on society. Alignment Healthcare Inc., for one, in 2022 released its inaugural ESG report highlighting efforts from the previous year that focused on delivering high-quality care at a lower cost compared to fee-for-service Medicare and addressing social determinants of health (SDOH). In 2023, The Cigna Group’s 98-page ESG report categorized similar efforts into four “pillars” — healthy society, healthy workforce, healthy company and healthy environment — and included efforts to reduce greenhouse gas emissions in the latter category.

In a 2022 podcast hosted by law firm K&L Gates LLP, speakers suggested that the health care industry by nature is “mission-driven…focused on the improvement of the human condition” and “is particularly well suited to address ESG issues.” And insurers’ efforts in recent years to address health inequities mirror the increased focus from the Biden administration and CMS on tying health equity to reimbursement, such as the CMS Innovation Center incorporating health equity into models that drive value-based care.

As Medicare Advantage insurers contemplate 2025 bids in an unfavorable funding environment, select firms that reported first-quarter 2024 earnings at press time indicated their preference for margin recovery versus growth and the likelihood of service area/benefit reductions next year. 

For the quarter ending March 31, 2024, CVS Health on May 1 reported consolidated revenues of $88.4 billion, reflecting year-over-year revenue growth of 3.7% that would have been larger if not for a decline in the Health Services segment. Meanwhile, first quarter adjusted earnings per share (EPS) dropped from $2.12 [or $2.20?] a year ago to $1.31, which the company attributed to utilization pressure in the Health Care Benefits segment’s MA business. That segment’s medical loss ratio (MLR) was 90.4%, compared with 84.6% in the prior-year quarter, while higher-than-expected medical costs of approximately $900 million — primarily driven by MA — were due to seasonal factors or items specific to the quarter, the company clarified.

For Medicaid-focused insurers facing the headwinds of the post-pandemic disenrollment backlog, a contract win can cause a major sigh of relief. That’s particularly true for Centene Corp., the largest managed Medicaid insurer in the U.S., which held onto three state contracts in Michigan, New Hampshire and Florida in recent months. Shares of Centene were up 3.5% following its April 12 win in Florida, where it currently serves 1.46 million members, according to AIS’s Directory of Health Plans (DHP).

Awards from Kansas and Georgia — where Centene is an incumbent — are expected to be announced in the coming weeks. Texas, meanwhile, is in the middle of a procurement process that could mean a plan switch for about 1.8 million beneficiaries. And it could spell the end of Centene’s winning streak. CEO Sarah London at the Barclays Global Healthcare Conference, held in March, said the company was “disappointed” in the scoring of its most recent Texas proposal, and planned to protest any contract loss. “I would say the biggest concern for the program overall is the idea that the results are going to force 1.8 million Medicaid members in Texas, which is a state that has a very high choice rate, to choose a different place,” London continued.

Amid concerns about utilization trends, a disappointing final rate notice, “headwinds” has been the dominant buzz word in Medicare Advantage for months. To gain a better understanding of the cost-containment levers MAOs can pull in the face of cost pressures, AIS Health, a division of MMIT, spoke with AArete Managing Director Paul Schuhmacher. In his work with the global management and technology consulting firm, Schuhmacher co-leads the payer practice, which supports approximately 120 plans across the U.S. 

Editor’s note: This interview has been edited for length and clarity.