Medicare Advantage stole the spotlight last week with a steady barrage of new reports, investigations, and Q2 payor results.
KFF kicked things off with its MA Enrollment and Key Trends Update, which showed that 54% of eligible Medicare beneficiaries – 32.8M people – are now enrolled in private MA plans.
- That’s quite the jump from just 19% in 2007, and the CBO projects that percentage to continue climbing to 64% by 2034.
- The report also underscored the high concentration of MA enrollment among a small number of firms, with UnitedHealthcare (29%) and Humana (18%) accounting for an eye-popping 47% of nationwide enrollees.
Things only heated up from there, with the Wall Street Journal publishing a home visit hit piece on the “one hour nurse visits that let payors collect $15 billion from Medicare.”
- The investigation found that major Medicare Advantage players frequently push nurses to make diagnoses during home health assessments, which often involves inaccurate diagnostic tests or deliberate misinterpretation of questionnaires.
- Right on cue, STAT scorched UnitedHealth with its own report on several of the same issues, particularly problems related to the QuantaFlo device used to identify peripheral artery disease during home visits.
CVS and Humana added to the action with their Q2 investor calls, which both highlighted headwinds for their Medicare Advantage operations.
- CVS lowered its full-year forecast after its MA business saw elevated utilization across inpatient, benefits, and pharmacy, with CEO Karen Lynch stepping back into her old role at the helm of Aetna to oversee $2B in cost-cutting.
- Humana also revealed that it will likely lose a “few hundred thousand” MA members next year after shrinking its benefits and exiting markets in an effort to improve margins, marking the first time the payor has predicted membership losses from culling its plans.
The Takeaway
There’s nothing like a few hit pieces and payors trimming their forecasts to lure out the Medicare Advantage doomsayers, but the MA program isn’t going anywhere, even if it isn’t quite the margin machine that it once was.
