Specialist background
- Over 15 years of experience in Medicare business development and market performance specialist responsible for Medicare Operations in the New Jersey Market
- Well-versed in strategic planning, financial analysis and leadership techniques to drive significant growth in Medicare Advantage products
- Knowledgeable on health plan operations, value-based solutions and finance to produce high-performing networks and industry-leading growth
- Well-placed to comment on a carrier’s annual Medicare Advantage growth planning process, including key inputs and outputs, decision timelines and owners
Questions
1.
In your mind, it would be just the competitive intensity has stepped up within PPO, and so they're not really losing, they're just not gaining as much as everybody else, because the number of plans has increased pretty materially?
2.
Why are people coming out with such competitive PPO products rather than HMO products?
3.
Has there been a lot of aggressive competition within PPO on the benefits side? Have there been a lot of small players who have entered? Where's the competition coming from on the PPO side?
4.
Is the competition more the national guys or more the regional guys that have drove the competition on the PPO side?
5.
Is it fair, then, to say that the regional guys are driving more of the competitiveness incrementally, or the national guys? Just because it sounds like if you want to think about just aggressive pricing, aggressive benefits, some of that's more on the regional side, but I just want to make sure that that's correct.
6.
Do you think that's specific to just New Jersey or do you think that's everywhere, where the regional guys are leading and it may be unsustainable, and the national guys are following in a more sustainable way? Do you think that's widespread across the country, or is that just really New Jersey, where with Clover in particular, AS is really a focus?
7.
Are we seeing any retrenchment here now? We've got 2023, where Centene is shedding some numbers, you've got some choppiness in the market, maybe, from the utilisation, you've got 2024 pricing getting a little bit better or more… actually worse, but making it more difficult to be super-aggressive on rate.
8.
I would imagine Clover is no longer being rewarded for growing as aggressively as possible, too. Are we seeing any change or retrenchment here in the market, or no?
9.
Have we seen that start already in 2023, or you're hypothesising that we should start to see that for 2024? I'm trying to think if there's any evidence we've seen already where people are maybe taking some of these steps already.
10.
When you say from some of the first looks you've seen, what does that mean? "We just didn't do a blank in terms of benefits. We've pulled back on our OTT card," or are you seeing the national plan data? What are you seeing that gives you the confidence to make that statement that benefits will be a little less aggressive in '24?
11.
Directionally, it's getting less competitive, is that correct?
12.
What are people focused on in '23 here, in terms of cost of care? You mentioned a little bit about that.
13.
If I look at just the… I think it's the state level insurance filing for MA, and I look at just the industry, and I take out the large public carriers, there's a whole slew of either small or non-profit guys who, for 2021 and 2022, had negative profitability. I'm assuming that '21 was obviously impacted by the risk scores, they had negative margins in '22, again, '23 we're having higher utilisation, so I'm assuming that hasn't likely gotten much better. Where do you think those margins for those players go in '24? Should margins overall for the non-publics get better, or should they get worse?
14.
When does that impact the carrier's rates and collections? What year do they feel the benefit or harm of that?
15.
Does it impact '24 or '25? I thought '24 was the one that came out October '22, am I right?
16.
Your point is that data that is being collected right now is still not great, is your point? Is that right?
17.
For next year, their star ratings were set. For '24, people knew their star ratings for that when they did June '23, obviously, but there's a bunch of people making negative margins the last couple of years, '23 I'm assuming they didn't get much better, just because of the utilisation here? Would you expect that people were conservative on their bids enough to improve their margins, or would you think they don't gain any headway, or should they get worse on their margins, the non-publics, generally?
18.
It's unclear whether or not Humana was aggressive or conservative yet, because you haven't gone through it?
19.
Does that mean, in your opinion, their margins should suffer in '24, or whether they should not, or any clue?
20.
How is utilisation right now? Is utilisation across the board? There's pressure in out-patient surgery, there's pressure elsewhere, maybe, maybe not, how would you characterise the utilisation environment?
21.
How do you bend the trend into '24? Is that just helping with the PCP capacity size? Is that making sure everything is right side of care? What do you guys do, you think, to bend the trend for '24, what you're seeing here?
22.
This is a separate topic, group MA, as a product, has grown slower than individual MA over the last three, four years, something like that. Why do you think that is, and would you expect that to continue?
23.
Would you expect group MA to grow slower than individual over the next few years, for that trend to continue?
24.
How's your thoughts, just generally, on Humana and their financial performance into '24? What's your outlook on their MA business for '24, especially given the current utilisation environment?
25.
They'll clearly grow a lot from that, but do you think they'll just get hosed on margins with profitabilities? You can always gain members that negative margin, right?
26.
I don't have any other questions, is there anything we haven't talked about that we should, when we talk about Humana, or the MA market, or whatnot?
27.
It makes sense to invest in the FMO as well?
28.
What's your confidence that that is correct? It just seems like such a weird thing to do, doesn't it?
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