Four Key Takeaways from AHIP

After a four year in-person hiatus, AHIP held it's Medicare, Medicaid, Duals, and Commercial Market Forum this week. Belong Health 's Gen Gillespie , Caroline Ririe , and Erin O’Brien had a chance to attend the three-day conference focused on policies, priorities, regulatory and compliance issues, and offer these four key takeaways.

#1. CMS' commitment to D-SNP is stronger than ever. Driving this commitment is:

Rapid growth in the Dual eligible population

• Transition from the “successful” MMP demonstration projects to D-SNP products
• 10x increase (to 1.75m) of enrolled Duals in integrated care products

CMS clearly believes that FIDE products (referred to as nirvana in one session) are the most promising structural vehicle to deliver on the promise of value-based care and triple-aim outcomes for Dual-eligible beneficiaries. However, it's on the plans to demonstrate results.

#2. The advance notice call letter presents headwinds for the Medicare Advantage industry and D-SNP plans. It's clear that the overall impact on risk-adjusted premiums for MA and D-SNP plans is negative in the short term, albeit with uneven impact depending on geography, member mix, and historical coding intensity. CMS does not view this as "test the waters" on rates, but as a true policy correction to update the risk adjustment methodology and benchmark years to a more contemporary view of spend. It’s also an adjustment for perceived overpayments to the industry during the pandemic.

As a result, connecting coding activity and disease burden to actionable care planning and interventions is more important than ever. Providers and plans face an increased sense of urgency to make sure they are collaborating effectively on health risk assessments, annual wellness visits, and access to care for their complex populations to deliver meaningful, person-centered care.

#3. Clear priority and focus on Health Equity throughout the conference. The announcement of Health Equity Index as a proposed STAR rating, health equity plan requirements for ACOs, plus the pilot of value-based supplemental benefit designs for things like "food as medicine" demonstrate the industry's commitment to advancing health equity. There was clear recognition that poverty is a key driver of poor health outcomes. However, CMS needs to work with the private sector to define and implement health equity programs. Until that happens, results and standards will vary wildly. Emphasis on data collection and standardization around equity, SDOH, and non-health related benefit usage seen as a critical underpinning to moving the needle on this front.

#4. Medicaid reform takes a back seat in the short-term so the industry can focus on a smooth redetermination and reconciliation process post-expiration of the public health emergency. Many plans estimate that their Medicaid enrollment could decline by 30% or more because of lost coverage. They anticipate 50% of those who lose Medicaid coverage are due to administrative issues, not eligibility. This will lead to a corresponding 40-50% increase in ACA marketplace enrollment. Even though CMS has launched its largest Medicaid outreach to date, 62% of adults on Medicaid are unaware of Medicaid redetermination. Big ideas on Medicaid reform will be deferred until the redetermination dust has settled.