"Extras have become table stakes in this competitive environment," says the payvider's chief Medicare officer, Britta Orr.
Focus on national Medicare Advantage (MA) headlines and you might miss some intriguing local dynamics—like what it means for a state to transition from Cost Plans to MA and how Allina Health | Aetna has become a leader in a market that didn't exist five years ago.
A great place to get those insights is from Britta Orr, Allina Health | Aetna's chief Medicare officer. Orr is responsible for driving Medicare strategy, directing functional areas for the provider-payer joint venture, and managing regulatory compliance.
Minnesota's shift from Cost Plan to MA market
If you hadn't thought about Medicare Cost Plans for a while, you can be forgiven. Until 2019, MA plan presence was limited in Minnesota. Original Medicare and Cost Plans ruled, causing what Allina Health | Aetna's CMO calls "an acute shift" in market dynamics.
Per a Congressional update in contract year (CY) 2016, service areas "where two or more competing local or regional Medicare Advantage (MA) coordinated care plans meet minimum enrollment requirements" must terminate their Cost Plan offerings over the course of the entire prior contract year. Cost Plans, now available in only a handful of states, offer Part A and Part B coverage with both offering the option to add drug coverage.
Orr states that $0 premium MA plans in Allina Health | Aetna's service area have seen 130% state growth since the shift from Cost Plans in 2019, the same year that Allina Health | Aetna launched its plan and introduced what Orr calls "positive disruption" in the form of MA's low premiums, added benefits, and out-of-pocket limits.
The MA planning cycle
Given that its MA planning cycles run two to three years, it's still early days for Allina Health | Aetna's MA strategy. In addition to the recurring bid process every MA plan grinds through, the payvider's annual cycle includes spring product planning based on consumer market signals, benefit choices, innovation, and unmet need.
Per Orr, the plan also looks out "years ahead of current bids from benefit design, marketing, training, selling, and serving"—including trends like the young Boomer social media use that helps define consumer communication strategy.
All this in addition to pricing.
"Pricing as close to the pin as possible"
During the 2022 MA Annual Enrollment Period (AEP), Humana's stock price plummeted after the payer adjusted its enrollment projections. Only in a market as organically hot as MA can notable, albeit lower-than-expected, growth be seen as a negative. Analysts believed Humana had priced too conservatively.
When asked about this and the role pricing would play in 2023 MA dynamics, Orr answered: "With benefits and pricing, our goal is to get to as close to the pin as possible. This is extremely important from a bid perspective," adding: "We want to avoid consumer cost volatility. We don't want to underprice and surprise with higher premiums later. Allina Health | Aetna has kept a stable portfolio year over year in the face of new entrants and enhanced benefits."
Leveraging national resources
About those enhanced MA benefits, Orr notes: "The extras have become table stakes in this competitive environment."
In delivering those extras, Allina Health | Aetna has access to something few state plans do: the national resources of CVS Health, Aetna's parent company.
"We have a Goliath in our corner," says Orr.
"We can reach into CVS and leverage technology, data, and analytics for targeted care," she adds, also noting the retailer's enhanced services HealthHUB Hub model, its Resources for Living service ("an Angi's list for health"), and OTC benefits.
As part of a "whole-person health" approach, Orr also named her plan's wraparound services, including post-discharge meals and a $100-per-quarter benefit card that can be used for medical copays and other out-of-pocket cost shares."
Consumerism comes in many forms
"I am always wearing the consumer hat. Our sales motto is the best benefit with no surprises," says Orr.
Noting that Allina Health | Aetna's very first MA Star Rating was a 4.5, Orr adds: "To compete on benefits, you must compete on high quality, provider partnership, and other collaborations, especially for high-need populations."
Orr also stresses the importance of the omnichannel, "Amazon-like experience" that healthcare consumers are looking for. For Allina | Aetna, that means meeting people where they're at and communicating with them in the ways they want. Plan engagement ranges from online portals to brick-and-mortar, storefront sites with local member advocates.
Orr sees Allina | Aetna's payvider model as another consumer benefit.
"It's an exciting model to be in close provider partnership," says Orr.
“We have a Goliath in our corner. We can reach into CVS and leverage technology, data, and analytics for targeted care.”
Britta Orr, chief Medicare officer, Allina Health | Aetna
Laura Beerman is a contributing writer for HealthLeaders.
KEY TAKEAWAYS
Orr spoke with HealthLeaders about her plan's Medicare Advantage strategies and planning cycles.
Specifics include pricing "close to the pin" and consumers' desire for an Amazon-like experience.
Orr also detailed how having a "Goliath in our corner"—CVS Health—helps her plan deliver.