I was listening to the call mainly to glean information on the Medicare Advantage market. You can right click here to listen to the call (Open in NEW WINDOW so you can refer to the commentary below while listening). I have some of what I consider the key aspects of the call (with the corresponding times) below.
From 6:15 to about 9:20 covers Coventry’s Private Fee for Service business, Network Based Business and Part D Business
- Regarding PFFS business, there is a strong likelihood that Coventry will exit this business at the end of 2009, especially the individual PFFS business. There are about 218,000 PFFS members currently with about 40,000 residing in their current Network based plan’s service area. The final decision has not been made at this point. Management will likely decide this by the end of this week.
- Regarding Coordinated Care Plans (Network Based Medicare Advantage Plans), management has a 5 point plan to improve and increase this business. This will be a focus for management to GROW the business in this space. Membership is currently 175,000 in this category.
- Part D is performing well and experienced enormous growth. Coventry is generally happy with this business.
From 24:45 to 27:30 discusses the transition of the PFFS business to Network business. According to Allen Wise, CEO, “It’s unlikely that there will be much in the way of a substantial piece left.” (with regard to PFFS).
32:15 to 33:15 discusses the group PFFS business (roughly 100,000 members in addition to the 218,000 individual members).
40:45 to 43:10 Question is asked as to whether a fix to the Physician’s Fee schedule (if added back to MA Capitation rates) would impact the decision to exit PFFS at the end of 2009. Short answer is no. Management would prefer to focus energies on growing and improving their network based product competencies.
1:08:15 to end Discussion of how network based MA business can compete with Original Medicare A & B coverage. Management believes they can deliver A&B equivalent costs currently at approximately 83% (excluding Vista) prior to any improvements (discussed in 5 point plan for improving Network Based MA). Discussion of how much additional benefit is required to induce member to enroll in MA versus original Medicare.
[...] 6, 2009 by Craig I talked about this last week (see blog post here), but yesterday, Coventry made it official that they are exiting the Private Fee for Service market [...]
Craig,
Thanks. I’m sure you will let us know as you find out info.
Craig,
What will they do with the existing PFFS client base? Will they disenroll them from the plans?
Also, do you know how 2010 changes will affect the Special Needs plans, particulary, the DUAL eligible plans like Advantra One or Evercare DH?
Mike:
1. Too soon to tell at this point. Some of the members live in the Service Area of PPO’s who could be moved to an alternate plan, but I think this would require some paperwork (I don’t think it will happen automatically). Again, it is early, but (assuming they decide to get out of the PFFS business), if the client doesn’t do anything, they would be disenrolled and put back on original medicare.
2. Regarding DUAL SNP plans, the sense I’m getting is that the funding cuts will not impact the DUAL SNP to the same extent as the other MA products.