Specialist
Former VP at Anthem Inc
Agenda
- Recent trends and developments within the US managed care market, focusing on Elevance Health (NYSE: ELV)
- Deep dive into Elevance’s behavioural health segment, noting relationship dynamics and value-based care challenges with Medicaid coverage
- Capabilities to recapture Medicaid contract losses following the PHE (public health emergency) redetermination
- Q2 2023 growth outlook and expansion opportunities, including virtual care shifts
Questions
1.
What major trends and developments have you been following in the behavioural health segment of the managed care space over the past year or so?
2.
The timeline CMS [Centers for Medicare & Medicaid Services] laid out in the Medicare drug price negotiation programme was by 1 September 2023, and the organisation will publish the first 10 Medicare Part D drugs selected for initial price applicability by the year starting 2026. How might the drug pricing reforms either negatively or positively impact Carelon’s prescription drug business?
3.
Elevance Health has roughly 486,000 behavioural health providers in its network vs roughly 350,000 primary care physicians in network. What’s your assessment on the overall breadth of the company’s mental health providers, delineating the relative access you’re seeing across its commercial, Medicaid and Medicare advantage members?
4.
What’s your take on the strength of the relationship Elevance has with its contracted Medicare and Medicaid behavioural health providers? Have you seen any initiatives that the company has deployed over the years to improve those provider relationships, especially in Medicare and Medicaid?
5.
What do you see as the main barriers to entry for value-based care, specifically in behavioural health, with Medicaid coverage? How effectively does Elevance integrate its Medicaid behavioural health provider systems, which we touched on?
6.
Do you think it’s better to own provider groups, forge partnerships or contract in a normal manner? Do you think this strategy or best practice differs when we’re looking at primary care physician or behavioural health groups?
7.
What is the likelihood of Elevance growing its behavioural health provider network through acquiring more provider groups? How might that broadly impact the company’s competitive positioning in the behavioural health space?
8.
Could you highlight the advancements you’ve seen Elevance make to improve its virtual care delivery methods within its behavioural health offering? How does the enhancement of digital platforms help to fill any gaps or areas of unmet need that currently exist in the behavioural health space?
9.
Carelon Behavioural Health extended its position in crisis management. It’s now serving as the managing entity to 988 Suicide & Crisis Lifeline for the New Jersey division of mental health and addiction services, which started in April 2023. How are you viewing Carelon’s ability to service this hotline, and what are some of the opportunities that stem from an engagement of this kind?
10.
Elevance announced the integration of Carelon’s Rx [prescription] pharmacy into its Sydney Health app, which is to serve home delivery modalities within its behavioural health coverage. How are you assessing the opportunity home delivery could provide for Carelon’s behavioural health offerings?
11.
The Medicaid PHE [public health emergency] redetermination is a significant headwind for managed care organisations. How are you viewing Elevance’s and other managed care organisations’ plans to raise premium rates to be able to cover the overall higher costs of care? How do you think this pricing strategy might impact Elevance and other players’ abilities to recapture lost Medicaid lives from the redetermination?
12.
Which specific US states do you expect to give Elevance a greater difficulty in being able to recapture the greatest number or percentage of Medicaid patients?
13.
What would you say is your 1-1.5-year strategic outlook for Elevance Health? What key factors do you think we should monitor over this time frame, or is there anything that you think is important to highlight that we haven’t touched on?
