Fourth-Quarter 2019 Data Posted; Reports Updated

The AIS Data Team has posted new data to the subscriber dashboard Online Search Tool and In-App Download Enrollment Data Spreadsheets. This data primarily reflects fourth-quarter 2019 status but includes some first-quarter 2020 data for Medicare Advantage, duals and some managed Medicaid data.

The majority of related in-app downloads and special reports now reflect the most recent data available. Keep an eye out later this month for a detailed analysis of changes since the third-quarter update. In the meantime, here are a few notable shifts since last quarter:

Blue Cross Blue Shield of Arizona (#708) in early 2020 acquired the Arizona Medicare and Medicare-Medicaid dual-eligibles business of Steward Health Choice (21), as well as its Medicaid contract in Arizona, representing a net increase of 195K.
PacificSource Health Plans (#804) increased its risk-based enrollment by nearly 50%, mainly due to its expansion into Lane, Polk and Marion counties via its Oregon managed Medicaid contract.
Paramount Insurance Company (#255) lost more than 30K managed Medicaid members in Ohio after it exited the central and southeast regions of the state due to financial losses.
CareSource (#257) lost more than 215K members, as its joint Medicaid plan in Kentucky with Humana moved entirely under Humana (#1109) starting in 2020. The insurer also lost members in Ohio as part of an overall downward shift in the state’s Medicaid program.
• Total membership for BlueCross BlueShield of South Carolina (#398) decreased by over 140K, primarily because its South Carolina Medicaid contract is now represented in Anthem, Inc. (#1264), which owns the plan’s Healthy Blue brand.
TRUSTED Health Plan (#1759) saw major changes since the last quarter; its Michigan-based Medicaid enrollment was phased into Health Alliance Plan (#177), which acquired it in September. In addition, CareFirst BlueCross BlueShield’s (#368) acquisition of its D.C. Medicaid business was finalized in January 2020. To reflect this, TRUSTED’s parent company is now CareFirst, Inc., until the business is fully consolidated into the parent company.

For this update, we added the following new MCOs:

• Health Pointe of New York, LLC (#1940), Medicare Advantage plan in New York;
• Reliance Medicare Advantage (#1982), an MA plan in Michigan;
• Clarion Health (#1983), an MA plan in Florida;
• KeyCare Advantage (#1988), an MA plan in Maryland;
• Mary Washington Medicare Advantage (#1989), an MA plan in Virginia;
• MoreCare (#1990), an MA plan in Illinois;
• ProCare Advantage (#1991), an MA plan in Texas;
• Troy Medicare (#1992), an MA plan in North Carolina;
• Zing Health (#1993), an MA plan in Illinois;
• FamilyHealth Center for Older Adults (PACE) (#1995), a PACE plan in California;
• Gary and Mary West PACE (#1996), a PACE plan in California;
• Auxilio Salud Plus (#1998), a commercial plan in Puerto Rico.
• Georgia Health Advantage (#1999), an MA plan in Georgia; and
• PACE North (#2000), a PACE plan in Michigan.

For this update, we discontinued the following new MCOs:
• Willamette Valley Community Health CCO (#673), which left the Medicaid market for 2020;
• Quality Health Plans of New York, Inc. (#800), which terminated its contract with CMS in March 2020;
• Western Grocers Employee Benefit Trust (#1579), because we determined its enrollment is already counted in PacificSource Health Plans (#804), which administers the plans;
• BeHealthy America, Inc. (#1827), which left the Medicare market as of Dec. 31, 2019; and
• PrimaryHealth of Josephine County (#1868), which left the Medicaid market for 2020.

One record changed its name in this update: Elder Service Plan of the Cambridge Health Alliance (#1789) became CHA PACE.

Finally, we made an enhancement to the Supplemental Programs-Public Sector in-app download; we added a new category, Partial Duals, which represents dual-eligible members served by Medicaid whose primary payer is Medicare. Currently, most members are assigned to their state Medicaid fee-for-service MCO ID, but as we are able to obtain more detailed breakdowns from state agencies, we expect to be better able to break these members out by insurer.

Need more help? Contact with questions about how to use or interpret the information provided to you in AIS’s Directory of Health Plans. A member of AIS Health’s support staff would be happy to provide a free demonstration of the website for clients needing more guidance on how to best use this tool.