News Brief 4/29/19: Thinking Ahead

Today I share two articles and my thoughts on key concepts. Keep these in the back of your mind as you prepare for 2020.

This morning, the Nevada Independent published an article referencing a sponsored bill requiring all hospitals in the state to accept Medicare and Medicaid. The legislation, according to the authors, is targeted at one hospital, Elite Medical Center, which is not enrolled in those two programs, and is also not in any private provider network.

This should be an interesting one to follow, with a state proposing to mandate participation in a federal program. (Rhode Island, an insurance market which is arguably one of the most difficult to enter, has seen its share of bills targeted towards one insurer, one hospital, one university, under the guise that “everyone has to do it”.) Nevadans may need to be careful of what they wish for, and determine if there is a true undue burden on the other facilities in the area.

In other news, Anthem told Managed Care magazine they had a 14% enrollment growth in Q1 in Medicare Advantage, pointing to their new benefit offerings targeting Social Determinants of Health (SDOH).

CMS’ rule change opened doors to insurers to give chronically ill patients with Medicare Advantage the option of accessing a range of benefits that are not necessarily health-related, but can improve or maintain their overall health, and Anthem jumped on that opportunity. The organization spent quite a bit of time in acquisition-mode, and in 2019 will now focus on the employer group markets and the dual eligibles of their current service areas, according to CEO Gail Boudreaux in an earnings call.

Watch for the Anthem (and other industry innovators) to get very creative with service offerings, but don’t expect insurers to provide transportation or home carpet cleaning themselves. Vendors entering this space will need to be mindful of the contractual obligations pushed down from a payer. Furthermore, expect a bumpy road in the implementation of these relationships until CMS provides additional oversight guidance.