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Lauren Flynn Kelly

Recent Posts

Trends That Matter for MCO's Role in COVID Vaccine Rollout

Posted by Lauren Flynn Kelly on Jan 14, 2021

States and the federal government recently began rolling out the COVID-19 vaccine to health care workers across the country. Health plans, particularly those that serve high-risk individuals, may be ideally situated to coordinate care and update members on vaccination opportunities, experts tell AIS Health.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. Then the agency on Dec. 18 authorized Moderna’s vaccine for emergency use in people 18 years or older.
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Topics: Market Access, Product Release, Data & Analytics, Payer

Radar On Market Access: MCO Messaging Plays Key Role in COVID Vaccine Rollout

Posted by Lauren Flynn Kelly on Dec 24, 2020

States and the federal government recently began rolling out the COVID-19 vaccine to health care workers across the country. Health plans, particularly those that serve high-risk individuals, may be ideally situated to coordinate care and update members on vaccination opportunities, experts tell AIS Health.

The FDA on Dec. 11 authorized emergency use of the COVID-19 vaccine made by Pfizer Inc. and BioNTech in individuals age 16 and older. Then the agency on Dec. 18 authorized Moderna’s vaccine for emergency use in people 18 years or older.

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Topics: Industry Trends, Market Access, Product Release, Payer

Radar On Market Access: MA Insurers Report Strong Performance, Predict Enrollment Growth

Posted by Lauren Flynn Kelly on Dec 1, 2020

Select publicly traded insurers reporting third-quarter 2020 earnings this past month predicted big gains in Medicare Advantage enrollment during the current Annual Election Period (AEP), and noted that growth in government products helped offset the impact of commercial losses and COVID-19 costs in the recent quarter, AIS Health reported.

Reporting third-quarter 2020 earnings on Nov. 6, CVS Health Corp. said a 3.5% year-over-year increase in overall revenues was due in part to growth in its Health Care Benefits segment, which includes Aetna. Revenues in that segment rose 8.8% from the prior-year quarter to $18.7 billion, primarily driven by membership increases in Aetna's government products and the favorable impact of the return of the Affordable Care Act health insurer fee for 2020.

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Topics: Data & Analytics, Payer

Perspectives on MA Star Ratings

Posted by Lauren Flynn Kelly on Nov 12, 2020

Although more than three-quarters of Medicare Advantage beneficiaries remain in highly rated plans, roughly 77% of MA Prescription Drug (MA-PD) members are currently in contracts that will have 4 or more stars in 2021, down from about 81% in 2020, estimated CMS.

Approximately 49% of MA-PD plans (194 contracts) that will be offered in 2021 earned overall star ratings of 4 or higher, compared with 52% of MA-PDs (210 contracts) offered in 2020, according to CMS.
 
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Average MA Star Ratings Fall Due to Increased Weights, Cut Points

Posted by Lauren Flynn Kelly on Oct 20, 2020

Although more than three-quarters of Medicare Advantage beneficiaries remain in highly rated plans, roughly 77% of MA Prescription Drug (MA-PD) members are currently in contracts that will have 4 or more stars in 2021, down from about 81% in 2020, estimated CMS.

Approximately 49% of MA-PD plans (194 contracts) that will be offered in 2021 earned overall star ratings of 4 or higher, compared with 52% of MA-PDs (210 contracts) offered in 2020, according to CMS.

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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter for Racial Disparities in MA Plans

Posted by Lauren Flynn Kelly on Jul 16, 2020

As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard look at health and access inequities, AIS Health reported.

Meanwhile, CMS's Office of Minority Research in April released a stratified report highlighting the racial and ethnic differences in health care experiences and care of Medicare Advantage (MA) enrollees. The data showed that black members enrolled in MA plans in 2018 received worse clinical care than white enrollees on 20 out of 44 measures, similar care for 20 and better care for four. And all minority populations reported experiences with care that were either worse than or similar to the experiences reported by white enrollees, including the experience measure for getting appointments and care quickly.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: CMS Report Shows Increasing Racial Disparities in MA Plans

Posted by Lauren Flynn Kelly on Jun 23, 2020

As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard look at health and access inequities, AIS Health reported.

Meanwhile, CMS's Office of Minority Research in April released a stratified report highlighting the racial and ethnic differences in health care experiences and care of Medicare Advantage (MA) enrollees. The data showed that black members enrolled in MA plans in 2018 received worse clinical care than white enrollees on 20 out of 44 measures, similar care for 20 and better care for four. And all minority populations reported experiences with care that were either worse than or similar to the experiences reported by white enrollees, including the experience measure for getting appointments and care quickly.

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Topics: Market Access, Provider, Payer

Radar On Market Access: 2021 MA, Part D Bids Face Challenges Amid COVID-19

Posted by Lauren Flynn Kelly on Jun 9, 2020

There are always uncertainties when it comes to projecting plan costs for the year ahead, but Medicare Advantage and Part D organizations that submitted bids on June 1 faced a particularly unpredictable set of circumstances created by the COVID-19 pandemic.

"I think we will all look back on the 2021 bids as the year of COVID-19," Brad Piper, a principal and consulting actuary in Milliman's Milwaukee office, tells AIS Health. "That was a big challenge for the organizations that are in the Medicare Advantage program — [perhaps more so] than on the Part D side — and it impacted both sides of the coin: costs and revenue."

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Radar On Market Access: Medicaid MCOs Are Likely to See COVID-Related Enrollment Growth

Posted by Lauren Flynn Kelly on Apr 23, 2020

As the COVID-19 pandemic continues to dominate the news cycle, headlines related to rising unemployment often underscore the impact to Medicaid, but what about the Medicaid managed care organizations that will absorb the newly jobless and uninsured?

"I think that Medicaid MCOs are clearly in the best position to handle the influx of folks," remarks Jerry Vitti, founder and CEO of Healthcare Financial, Inc. While onboarding a wave of new members may put some initial stress on plans, the real "strain" will come from covering new members who have unmet health care needs, he tells AIS Health.

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Topics: Industry Trends, Provider, Payer

Radar On Market Access: Amid COVID-19 Outbreak, CMS Relaxes Rules on MA Data Collection

Posted by Lauren Flynn Kelly on Apr 7, 2020

As efforts to contain the outbreak of COVID-19 continue to evolve, the Trump administration on March 30 issued a series of new flexibilities aimed at increasing hospital and provider capacity. At the same time, CMS in a March 30 memo provided some respite to Medicare Advantage and Part D plans dealing with the crisis by suspending audit and quality reporting activities so that plans and states can focus on providing care to the increasing number of beneficiaries affected by the new coronavirus, AIS Health reported.

As physicians cater to patients who are or may be infected with COVID-19, and as the federal government advises adults to delay elective surgeries and nonessential procedures during the outbreak, plans are likely to face issues with reporting quality data used to determine future star ratings.

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Topics: Industry Trends, Provider, Payer