2012 Benefits Provider Town Hall

Report
CAPG/HASC Contracting Committee
Medicare Advantage Discussion
Greg Wright
President, West Region
October 3, 2013
Agenda
• About UnitedHealthcare Medicare & Retirement
• Market Dynamics
– California Medicare Advantage membership
– California market and history
– LA story: Membership growth from 2010-2013
– Comparison of markets: LA and Northern CA
• Revenue
– Challenges
– Opportunities
• Summary
2
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
UnitedHealthcare Medicare & Retirement
Our Mission
Provide innovative health and well-being
solutions to help Medicare beneficiaries live
healthier and more secure lives
We Serve
Approximately 9.8 million members, nearly
one in five Medicare beneficiaries
• 2.9 million Medicare Advantage members
Our Products
• 4.7 million Part D Plan members
• 3.3 million Medicare Supplement enrollees
• 935,000 group retiree members
We Are
The largest business dedicated to the health
and well-being needs of seniors and other
Medicare beneficiaries
3
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Market Dynamics
AARP® MedicareComplete® from
SecureHorizons®
Los Angeles County
4
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
UnitedHealthcare – California
Medicare Advantage Membership
• Over 340,000 members
• YTD net growth
over 7,000 members
Medicare Advantage Market Share,
September 2013
Humana
Aetna
Care1st
Other
WellCare
• 17% market share,
second only to Kaiser
Blue Shield
WellPoint
Kaiser
Scan
Health Net
United
Healthcare
5
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Medicare Advantage Market
• California highly competitive
– Greater Los Angeles market hyper-competitive
• Traditionally richer benefits than average
• More plans competing on benefits
– Northern California increasingly competitive
• UnitedHealthcare strategy
– Benefits vary based on market dynamics
– Greater LA benefits more aggressive due to
competitive environment
• Mixed messages from provider groups
6
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
History in the Market
• PacifiCare/UnitedHealthcare historical market leader
– Kaiser market leader since BBA era
– New entrants eroding UHC market share since MMA
• 2014 revenue pressure analogous to 2010
– Anticipated revenue cuts of 5%
– Groups offset revenue cuts with coding initiatives
• Lesson of 2010
– UHC cut benefits
– Rest of market generally stood pat
– UHC fell behind market and lost membership
7
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Los Angeles County Membership
Growth, 2010-2013
Members
CMS
Rank Medicare Advantage Plan
June '13
Growth
2010
2011
2012
207,166
10,525
10,820
15,166
YTD '13 Notes
‘12 5 Stars; ‘13 increased IP to
6,491 $170/day
15
Kaiser
11
UnitedHealthcare
82,010
(5,332)
2,022
1,734
1,865 ‘10 increased IP to $150/day
4
Anthem/WellPoint/Caremore
52,049
5,024
6,231
5,168
1,456 PPO and C-SNP emphasis
9
Scan
51,393
(236)
(1,437)
928
5,204 ‘10 increased OP to $100
5
Easy Choice
31,034
3,666
4,561
14,312
5,088 low income/D-SNP focus
7
Health Net
28,488
1,872
(2,973)
2,772
10
Blue Shield
27,903
3,837
1,288
(1,051)
6
Care1st
10,703
(719)
1,713
831
1,551 low income/D-SNP focus
2
Central Health Plan
10,233
1,572
3,040
1,756
(623) Chinese focus; low Stars
3
Citizens Choice
8,401
1,644
636
(2,187)
8
InterValley Health Plan
5,047
152
(1)
(102)
13
Aetna
4,348
225
(532)
431
12
Humana (formerly MD Care)
3,372
1,541
154
(1,390)
14
Universal Care
960
128
63
289
1
Golden State
102
-
45
36
Grand Total
532,396
24,468
26,933
40,670
2,795 sanction 2011
(559) ‘12 network disruption
1,129 ‘12 network disruption
105 Pomona Valley plan
390 sanction 2011
(1,149) ‘10-11 MD Care, $0 copays
141 low income/D-SNP focus
21 Leisure World plan
25,581
8
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Comparison of Markets – Los Angeles
and Northern California
• Greater Los Angeles
– Hyper-competitive
– Over a dozen major competitors
– Nearly everyone offers $0 premium, $0 copay plans,
including UHC
• Northern California
– Higher cost structure
– Lower CMS revenue
– Plans typically have monthly member premiums
– Competitors under-cutting on premium
9
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Revenue
AARP® MedicareComplete® from
SecureHorizons®
Los Angeles County
10
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Revenue Challenges
• RAF/HCCs
– Recalibration
– FFS normalization
– ICD-10 conversion
• Star Ratings
– Must be at 4 Stars in ‘14 for quality bonus in ’15
– Full phase-in of shared savings / rebate formula
• Health Care Reform
– Rate reductions by county (quartiles)
– Premium Tax
11
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Revenue Opportunities
• RAF/HCCs
– Coding initiatives
– New members
• Star Ratings
– 2014 Star Ratings will impact 2015 revenue
– 2013 DOS will impact 2016 revenue
• Members
– Increased copays
– Increased membership volume
12
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
We Are All in This Together
• Ride the revenue trend together
• Additional revenue through growth
– Conversion of FFS patients
– Baby Boomers aging in
– Kaiser a common threat
• Opportunities to collaborate
– Benefits based on market dynamics
– Strategic relationships
– Quality initiatives
– Growth
13
Confidential
Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth
Group.UHC2161a* 2223a
Questions and Discussion
Thank you for your engagement!

similar documents