Georgia Managed Care Update Forum Overview

 
Welcome! The Georgia Managed Care Update Forum will begin shortly.
 
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Georgia Managed Care Update
 
Top Players
Market Trends
Value Based Care
Wrap-Up & Questions
 
 
 
 
 Top Players
 Top Players
 
Anthem BCBSGA Footprint
 
Product Portfolio:
Commercial/State Health Plans-60% statewide market shareholder 
(65-70% outside Atlanta)
PPO: 30% of Anthem Business
HMO: 70% of Anthem Business
State Health: 98% market share holder outside of Atlanta
Roughly 25-30% of Anthem’s commercial membership statewide
Medicare Advantage: Immaterial product line
Medicaid Managed Care: Amerigroup
 
 
 
 
 
 
 
 
Perceived Carrier Goals:
Physicians:
Shift physician fee for service pricing toward E&Ms/away from surgical/ancillary revenue.
Implement mid-level enrollment/billing for savings.
Hospitals:
Desire to move hospitals to a standardized agreement (Comprehensive Outpatient Prospective
Payment System – COPPS).
Continue to implement/enforce site of service policies designed to shift volume to free standing
providers.
Reduce cost via payment policy/administrative adjustments.
Product Lines:
Retrench Pathways product to lower pricing/move to more profitable deployment.
Establish Medicare Advantage market as statewide payer.
 
5
 
Anthem BCBSGA
 
UHC Market Footprint
 
Product Portfolio:
Commercial/State Health Plans-14% statewide market shareholder; 10% outside Atlanta
State Health:
Actives-2% market share holder outside of Atlanta
Retirees- 98% of market share in Medicare Advantage
30-40% of UHCMA Statewide membership
Medicare Advantage:
Outside of Atlanta: 60% market share holder for MA products; 85-90% in rural areas.
Lost non-SHBP market share in non-Atlanta markets over past 3 years.
Alternative Networks- Worker’s Comp/Auto, etc. Attempting to build out currently.
Medicaid Managed Care:
Attempt to be added as “4
th
 CMO” pending WellCare/PSHP merger
Per DCH, no additions to CMO roster will be made until next RFP in 2023.
Overall, generated record profits in the midst of an international pandemic.
 
 
 
 
 
 
 
 
Perceived Carrier Goals:
Physicians:
Roll out point of care platform to ease administrative burden/improve quality. Currently no financial
incentive to utilize.
Hospitals:
Continue to implement/enforce site of service policies designed to shift volume to free standing
providers (Lab/Rad).
Reduce cost differential vs. BCBS via unit cost reductions.
Product Lines:
Return to dominance in non-Atlanta Medicare Advantage via creating pricing advantages.
Establish additional lines of business for worker’s comp, auto, and other types of coverage.
Gain access to Georgia Medicaid program.
 
7
 
UHC
 
Aetna Market Footprint
 
Commercial/State Health Plans-11% statewide market shareholder; 11% outside of Atlanta
PPO: 30% of Aetna business
HMO: 70% of Aetna business
Meritain: largest non-carrier claims administrator in market; owned by Aetna
State Health:
Planning to bid during next RFP in 2021 for 2022-2026 contract cycle
Medicare Advantage:
Statewide participation/Quickly growing product line for Aetna.
CVS Acquires Aetna in 2018
Pilot Programs-building care delivery model around CVS stores.
Launched CVS/Aetna Health Hub Pilots in 2019: plan to grow to 1500 locations in the next 24 months
Announced in 2020:
Social Determinants of Health
Outcomes on Knee Replacement Surgery
 
 
 
 
 
 
 
Perceived Carrier Goals:
Physicians:
Roll out value based plans to improve physician satisfaction/improve care.
Hospitals:
Continue to implement/enforce site of service policies designed to shift volume to free standing
providers (Lab/Rad). Softer approach currently.
Product Lines:
Become an option for State Health Benefit Plan for 2022.
Build network for health exchange deployment in 2022.
Continue to grow Medicare Advantage product line.
Compete in claims administration business via Meritain.
 
9
 
Aetna
 
Cigna Market Footprint
 
Product Portfolio:
Commercial: 11% statewide market shareholder; 8% outside Atlanta
Virtually all business is national/regional that has Georgia covered lives.
PPO/HMO: adjudicated on a similar platform; therefore, not administratively different.
Flat market share for several years running.
Medicare Advantage:
Healthspring is immaterial; product line not sold outside of Atlanta market.
 
Carrier Goals (Outside of Atlanta):
Reduce commercial pricing to compete with BCBS.
Continue to support national/regional business with complete network/price competition.
 
 
 
 
 
Humana Market Footprint
 
Product Portfolio:
Commercial/State Health Plans-7% statewide market shareholder
PPO: 40% of Humana business
HMO/POS: 60% of Humana business
Gained some market share over past 2 years via small group, self funded line of business
Planned commercial expansion across Southwest Georgia
Medicare Advantage:
Somewhat growing product line
 
Carrier Goals (Outside of Atlanta):
Grow Medicare Advantage product line.
Grow niche lines like level-funded/small self funded products.
 
 
 
 
 
 
Centene Market Footprint 
(Peach St/Ambetter/Wellcare)
 
Product Portfolio:
Medicaid Managed Care:
Largest CMO in state post Wellcare purchase
Health Exchange
Largest health exchange membership in state. Likely only carrier in majority of GA counties for 2021
Medicare Advantage:
Deployed statewide under “Wellcare” product name for foreseeable future
Somewhat growing outside of Atlanta
Carrier Goals (Outside of Atlanta):
Implement remaining territory vacated by BCBS for 2021
Execute Wellcare CMO network merge in 2021
Grow all 3 product lines
 
 
 
 
 
 
CareSource Market Footprint
 
Product Portfolio:
Medicaid Managed Care:
3
rd
 largest CMO in state post Peach State/Wellcare combination
Health Exchange
Rolling out participation in certain markets for 2021. Statewide by 2022
Medicare Advantage:
Launching Medicare product for 2021 in certain markets. Adding territory in 2022
Carrier Goals (Outside of Atlanta):
Grow CMO product line
Launch health exchange/MA product lines in 2021/brand for growth
Position as more friendly provider “partner”
 
 
 
 
 
 
Global Concerns With Payers
 
Nationalization of Provider Support
National Call numbers/generalized inboxes for provider inquiries
Standardized contract formats/ancillary pricing
Payer Policy Changes- Tantamount to fee schedule adjustments in some cases
Lab/Radiology/Therapy redirection towards free standing centers
Unilateral Physician Fee Schedule Adjustments
Anthem – New fee schedule 11/15/20
UHC MA- Sub-Medicare reimbursement
Cigna
Lack of Fee Schedule Transparency
Anthem Unilateral Rate Amendments without full fee schedules
Cigna: releases only 20 codes at a time via a portal request
Underpayments
Affects almost all payers and unless plans are fully funded; only have 3-12 months to appeal
All Products Contracts
Anthem Pathways: Removing  ability to term by product line
UHC: Leveraging state health contract to ensure all products participation
 
Fragmented Oversight
 
Department of Insurance (DOI)
In theory, fully insured commercial carrier issues only but they avoid health exchange issues like the plague.
New commissioner testing waters to engage beyond fully insured.
Department of Community Health (DCH)
Traditional Medicaid and CMO issues.
Much improved support during Blake Fulenwider/Frank Berry time.
Department of Labor (DOL)
In theory, oversees commercial self funded claim issues/disputes but support is non-existent.
Centers for Medicare and Medicaid (CMS)
Oversees traditional Medicare and Medicare Advantage issues.
In theory, applies standards for network adequacy for MA plans. Minimal oversight; overall belief that providers have a methodology for resolving MA issues by suing
the health plans.
Federal Department of Health and Human Services (HHS)
Oversees Medicare/Medicaid plus more directly responsible for Health Exchange carriers/network adequacy. Terrible support.
Department of Defense (DOD)
Oversees Tri-Care issues….sort of…..
All issues appear delegated to intermediary (Humana); seemingly disengaged support.
State/Federal Legislators- When all else fails……
 
 
 
 
Value Based Care
Value Based Care
 
Value Based Care- Primary Care Models
 
Blue Cross Blue Shield Enhanced Primary Care Program
Humana Model Practice Engagement- MA and Commercial
Aetna PCMH (Patient Centered Medical Home)
WellCare Shared Savings
Peach State Health Plan: launching new shared savings model for 2021
 
 
Value Based Care- Specialist Models
 
Aetna
Cardiology
Obstetrics/Gynecology
Oncology
Orthopedics
BCBSGA Patient Centered Specialty Care
EPHC Model for Specialists with Care Coordination Fees: Cardiology; Endocrinology &
Obstetrics/Gynecology
BCBSGA Enhanced Payment Bundles
Non-capitated bundled payment initiatives for specialists:
Gastroenterology
Orthopaedics
Obstetrics/Gynecology
Urological
Humana Oncology Model of Care
 
Value Based Care-CMS
 
Centers for the Medicare and Medicaid Innovation
Medicare Shared Savings Program ACOs
Bundled Care Payment Initiative
CPC+
Direct Contracting Model
MSSP ACOs are the most prevalent CMMI innovations
In performance year 2017; CMS announced that ACOs had saved $1.1. billion
CMS pushing value based care in State Medicaid contracts
 
Clover DCE
 
New traditional Medicare opportunity launching April 2021
Direct contract between Clover & CMS to manage a population of
red, white & blue Medicare lives
Key Features:
$4 PMPM
$20 Clover Assistant Bonus on E&Ms
Opportunity for Shared Savings
Full CMS claims feed data
Easier transition into value-based care
 
 
Market Trends
Market Trends
 
What’s Next/What Do We Do? 
Commercial Market
 
Market Diversification is key. Too close to being South Carolina or Alabama.
Support other carrier commercial product lines.
Support non-BUCA product offerings (Benecon, Alliant, etc.).
Develop/participate in community network offerings.
Upgrade outreach to DOI
More complaints.
Quarterly meetings.
Multiple sources (MAG/GHA/HTH).
Support any legislative effort to:
Implement/enforce network adequacy standards.
Improve all product enforcement.
 
 
 
 
 
 
What’s Next/What Do We Do? 
State Health
 
SHBP and BOR (University System) currently are contracted through Anthem of GA (BCBS)
and UHC and Kaiser (Atlanta only)
Anthem HMO- 98% share of active enrollees
UHC MA- 98% share of retirees
Upcoming RFPs
BOR RFP released previously for 2022 implementation
SHBP RFP pushed for 2022 implementation
Aetna plans to bid
Next Steps:
Support additional bidders to diversify membership.
Lobby DCH for more diversify with retirees.
Encourage equivalent member premium between carriers to spread active membership.
 
 
 
 
 
What’s Next/What Do We Do? 
Medicare Advantage
 
38% of Georgia Medicare enrollees in a Medicare Advantage plan as of January 2020
Market Disrupters
Clover
CareSource Medicare
EON
Pruitt Healthcare (Special Needs Plan)
Georgia Assurance(Special Needs Plan)
Next Steps:
Support non-UHC players in market (Clover/CareSource, etc.)
Be leery of BCBS MA growth.
Lobby DCH for more SHBP diversify with retirees.
Engage value based initiatives as brought forward.
 
 
 
 
 
 
 
 
What’s Next/What Do We Do? 
CMOs
 
Current Players:
Amerigroup
CareSource
Peach State Health Plan
WellCare
Coming Developments
PSHP Assumption of WellCare Medicaid in May 2021
Next Steps:
Lobby for no UHC/Full reattribution by DCH (vs. dumping into Peach State).
Ensure Peach State/Wellcare merger not harmful to organization.
Engage value based initiatives when brought forward.
 
 
 
 
 
 
 
 
 
What’s Next/What Do We Do? 
Health Exchange
 
Anticipated 2021 Adjustments:
Anthem Pathways
Anticipated to leave multiple additional counties.
Ambetter
Closest to Statewide carrier: In 2021; Ambetter will be in over 90% of Georgia counties.
CareSource
Continues to grow county offerings.
Alliant
Making a new market push in South/North Georgia.
Aetna
Planning new product development for 2020.
Next Steps:
Be leery of Pathways terminations. Might just be a county they are leaving.
Support diversification, even if to hold Ambetter accountable as well.
 
 
 
 
 
 
 
What’s Next/What Do We Do? 
COVID-19
 
State of Georgia: employer based coverage down 9% from February to June 2020.
National Expectations are rise in:
Medicaid/CMO
Health Exchanges
Higher Self-Pay
Some facilities already seeing a 30-50% increase in self-pay from pre-COVID levels
Next Steps:
Project volume based on shift in payer mix for internal and HHS reporting purposes.
Verify coverage like your life depends on it.
 
 
 
 
 
 
 
Wrap Up & Questions
Slide Note
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The Georgia Managed Care Update Forum is a crucial event discussing market trends, value-based care, and top players in the managed care industry. Key players like Anthem BCBSGA and UHC are highlighted, including insights on their goals and market footprints. Topics such as product portfolios, market shares, and strategic initiatives in Medicare Advantage and Medicaid managed care are covered in-depth. Stay informed about the latest developments in the managed care landscape through this comprehensive update.

  • Managed Care
  • Georgia
  • Market Trends
  • Value-Based Care
  • Healthcare

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  1. Welcome! The Georgia Managed Care Update Forum will begin shortly. To participate with audio by phone (mute/unmute, press *6): 1. Select the gear icon on the right control panel 2. Select the Phone option 3. Be sure to enter your Audio PIN so we can help answer your questions! To participate with audio via your PC (mute/unmute using mic icon): Ensure the right mic/speakers are selected under the Computer option. Please mute yourself when you are not speaking. You can also ask questions via the Chat feature: This meeting will be recorded.

  2. Georgia Managed Care Update Top Players Market Trends Value Based Care Wrap-Up & Questions shpllc.com | 912-691-5711

  3. Top Players shpllc.com | 912-691-5711

  4. Anthem BCBSGA Footprint Product Portfolio: Commercial/State Health Plans-60% statewide market shareholder (65-70% outside Atlanta) PPO: 30% of Anthem Business HMO: 70% of Anthem Business State Health: 98% market share holder outside of Atlanta Roughly 25-30% of Anthem s commercial membership statewide Medicare Advantage: Immaterial product line Medicaid Managed Care: Amerigroup shpllc.com | 912-691-5711

  5. Anthem BCBSGA Perceived Carrier Goals: Physicians: Shift physician fee for service pricing toward E&Ms/away from surgical/ancillary revenue. Implement mid-level enrollment/billing for savings. Hospitals: Desire to move hospitals to a standardized agreement (Comprehensive Outpatient Prospective Payment System COPPS). Continue to implement/enforce site of service policies designed to shift volume to free standing providers. Reduce cost via payment policy/administrative adjustments. Product Lines: Retrench Pathways product to lower pricing/move to more profitable deployment. Establish Medicare Advantage market as statewide payer. shpllc.com | 912-691-5711 5

  6. UHC Market Footprint Product Portfolio: Commercial/State Health Plans-14% statewide market shareholder; 10% outside Atlanta State Health: Actives-2% market share holder outside of Atlanta Retirees- 98% of market share in Medicare Advantage 30-40% of UHCMA Statewide membership Medicare Advantage: Outside of Atlanta: 60% market share holder for MA products; 85-90% in rural areas. Lost non-SHBP market share in non-Atlanta markets over past 3 years. Alternative Networks- Worker s Comp/Auto, etc. Attempting to build out currently. Medicaid Managed Care: Attempt to be added as 4thCMO pending WellCare/PSHP merger Per DCH, no additions to CMO roster will be made until next RFP in 2023. Overall, generated record profits in the midst of an international pandemic. shpllc.com | 912-691-5711

  7. UHC Perceived Carrier Goals: Physicians: Roll out point of care platform to ease administrative burden/improve quality. Currently no financial incentive to utilize. Hospitals: Continue to implement/enforce site of service policies designed to shift volume to free standing providers (Lab/Rad). Reduce cost differential vs. BCBS via unit cost reductions. Product Lines: Return to dominance in non-Atlanta Medicare Advantage via creating pricing advantages. Establish additional lines of business for worker s comp, auto, and other types of coverage. Gain access to Georgia Medicaid program. shpllc.com | 912-691-5711 7

  8. Aetna Market Footprint Commercial/State Health Plans-11% statewide market shareholder; 11% outside of Atlanta PPO: 30% of Aetna business HMO: 70% of Aetna business Meritain: largest non-carrier claims administrator in market; owned by Aetna State Health: Planning to bid during next RFP in 2021 for 2022-2026 contract cycle Medicare Advantage: Statewide participation/Quickly growing product line for Aetna. CVS Acquires Aetna in 2018 Pilot Programs-building care delivery model around CVS stores. Launched CVS/Aetna Health Hub Pilots in 2019: plan to grow to 1500 locations in the next 24 months Announced in 2020: Social Determinants of Health Outcomes on Knee Replacement Surgery shpllc.com | 912-691-5711

  9. Aetna Perceived Carrier Goals: Physicians: Roll out value based plans to improve physician satisfaction/improve care. Hospitals: Continue to implement/enforce site of service policies designed to shift volume to free standing providers (Lab/Rad). Softer approach currently. Product Lines: Become an option for State Health Benefit Plan for 2022. Build network for health exchange deployment in 2022. Continue to grow Medicare Advantage product line. Compete in claims administration business via Meritain. shpllc.com | 912-691-5711 9

  10. Cigna Market Footprint Product Portfolio: Commercial: 11% statewide market shareholder; 8% outside Atlanta Virtually all business is national/regional that has Georgia covered lives. PPO/HMO: adjudicated on a similar platform; therefore, not administratively different. Flat market share for several years running. Medicare Advantage: Healthspring is immaterial; product line not sold outside of Atlanta market. Carrier Goals (Outside of Atlanta): Reduce commercial pricing to compete with BCBS. Continue to support national/regional business with complete network/price competition. shpllc.com | 912-691-5711

  11. Humana Market Footprint Product Portfolio: Commercial/State Health Plans-7% statewide market shareholder PPO: 40% of Humana business HMO/POS: 60% of Humana business Gained some market share over past 2 years via small group, self funded line of business Planned commercial expansion across Southwest Georgia Medicare Advantage: Somewhat growing product line Carrier Goals (Outside of Atlanta): Grow Medicare Advantage product line. Grow niche lines like level-funded/small self funded products. shpllc.com | 912-691-5711

  12. Centene Market Footprint (Peach St/Ambetter/Wellcare) Product Portfolio: Medicaid Managed Care: Largest CMO in state post Wellcare purchase Health Exchange Largest health exchange membership in state. Likely only carrier in majority of GA counties for 2021 Medicare Advantage: Deployed statewide under Wellcare product name for foreseeable future Somewhat growing outside of Atlanta Carrier Goals (Outside of Atlanta): Implement remaining territory vacated by BCBS for 2021 Execute Wellcare CMO network merge in 2021 Grow all 3 product lines shpllc.com | 912-691-5711

  13. CareSource Market Footprint Product Portfolio: Medicaid Managed Care: 3rd largest CMO in state post Peach State/Wellcare combination Health Exchange Rolling out participation in certain markets for 2021. Statewide by 2022 Medicare Advantage: Launching Medicare product for 2021 in certain markets. Adding territory in 2022 Carrier Goals (Outside of Atlanta): Grow CMO product line Launch health exchange/MA product lines in 2021/brand for growth Position as more friendly provider partner shpllc.com | 912-691-5711

  14. Global Concerns With Payers Nationalization of Provider Support National Call numbers/generalized inboxes for provider inquiries Standardized contract formats/ancillary pricing Payer Policy Changes- Tantamount to fee schedule adjustments in some cases Lab/Radiology/Therapy redirection towards free standing centers Unilateral Physician Fee Schedule Adjustments Anthem New fee schedule 11/15/20 UHC MA- Sub-Medicare reimbursement Cigna Lack of Fee Schedule Transparency Anthem Unilateral Rate Amendments without full fee schedules Cigna: releases only 20 codes at a time via a portal request Underpayments Affects almost all payers and unless plans are fully funded; only have 3-12 months to appeal All Products Contracts Anthem Pathways: Removing ability to term by product line UHC: Leveraging state health contract to ensure all products participation shpllc.com | 912-691-5711

  15. Fragmented Oversight Department of Insurance (DOI) In theory, fully insured commercial carrier issues only but they avoid health exchange issues like the plague. New commissioner testing waters to engage beyond fully insured. Department of Community Health (DCH) Traditional Medicaid and CMO issues. Much improved support during Blake Fulenwider/Frank Berry time. Department of Labor (DOL) In theory, oversees commercial self funded claim issues/disputes but support is non-existent. Centers for Medicare and Medicaid (CMS) Oversees traditional Medicare and Medicare Advantage issues. In theory, applies standards for network adequacy for MA plans. Minimal oversight; overall belief that providers have a methodology for resolving MA issues by suing the health plans. Federal Department of Health and Human Services (HHS) Oversees Medicare/Medicaid plus more directly responsible for Health Exchange carriers/network adequacy. Terrible support. Department of Defense (DOD) Oversees Tri-Care issues .sort of .. All issues appear delegated to intermediary (Humana); seemingly disengaged support. State/Federal Legislators- When all else fails shpllc.com | 912-691-5711

  16. Value Based Care- Primary Care Models Blue Cross Blue Shield Enhanced Primary Care Program Humana Model Practice Engagement- MA and Commercial Aetna PCMH (Patient Centered Medical Home) WellCare Shared Savings Peach State Health Plan: launching new shared savings model for 2021 shpllc.com | 912-691-5711

  17. Value Based Care- Specialist Models Aetna Cardiology Obstetrics/Gynecology Oncology Orthopedics BCBSGA Patient Centered Specialty Care EPHC Model for Specialists with Care Coordination Fees: Cardiology; Endocrinology & Obstetrics/Gynecology BCBSGA Enhanced Payment Bundles Non-capitated bundled payment initiatives for specialists: Gastroenterology Orthopaedics Obstetrics/Gynecology Urological Humana Oncology Model of Care shpllc.com | 912-691-5711

  18. Value Based Care-CMS Centers for the Medicare and Medicaid Innovation Medicare Shared Savings Program ACOs Bundled Care Payment Initiative CPC+ Direct Contracting Model MSSP ACOs are the most prevalent CMMI innovations In performance year 2017; CMS announced that ACOs had saved $1.1. billion CMS pushing value based care in State Medicaid contracts shpllc.com | 912-691-5711

  19. Clover DCE New traditional Medicare opportunity launching April 2021 Direct contract between Clover & CMS to manage a population of red, white & blue Medicare lives Key Features: $4 PMPM $20 Clover Assistant Bonus on E&Ms Opportunity for Shared Savings Full CMS claims feed data Easier transition into value-based care shpllc.com | 912-691-5711

  20. Whats Next/What Do We Do? Commercial Market Market Diversification is key. Too close to being South Carolina or Alabama. Support other carrier commercial product lines. Support non-BUCA product offerings (Benecon, Alliant, etc.). Develop/participate in community network offerings. Upgrade outreach to DOI More complaints. Quarterly meetings. Multiple sources (MAG/GHA/HTH). Support any legislative effort to: Implement/enforce network adequacy standards. Improve all product enforcement. shpllc.com | 912-691-5711

  21. Whats Next/What Do We Do? State Health SHBP and BOR (University System) currently are contracted through Anthem of GA (BCBS) and UHC and Kaiser (Atlanta only) Anthem HMO- 98% share of active enrollees UHC MA- 98% share of retirees Upcoming RFPs BOR RFP released previously for 2022 implementation SHBP RFP pushed for 2022 implementation Aetna plans to bid Next Steps: Support additional bidders to diversify membership. Lobby DCH for more diversify with retirees. Encourage equivalent member premium between carriers to spread active membership. shpllc.com | 912-691-5711

  22. Whats Next/What Do We Do? Medicare Advantage 38% of Georgia Medicare enrollees in a Medicare Advantage plan as of January 2020 Market Disrupters Clover CareSource Medicare EON Pruitt Healthcare (Special Needs Plan) Georgia Assurance(Special Needs Plan) Next Steps: Support non-UHC players in market (Clover/CareSource, etc.) Be leery of BCBS MA growth. Lobby DCH for more SHBP diversify with retirees. Engage value based initiatives as brought forward. shpllc.com | 912-691-5711

  23. Whats Next/What Do We Do? CMOs Current Players: Amerigroup CareSource Peach State Health Plan WellCare Coming Developments PSHP Assumption of WellCare Medicaid in May 2021 Next Steps: Lobby for no UHC/Full reattribution by DCH (vs. dumping into Peach State). Ensure Peach State/Wellcare merger not harmful to organization. Engage value based initiatives when brought forward. shpllc.com | 912-691-5711

  24. Whats Next/What Do We Do? Health Exchange Anticipated 2021 Adjustments: Anthem Pathways Anticipated to leave multiple additional counties. Ambetter Closest to Statewide carrier: In 2021; Ambetter will be in over 90% of Georgia counties. CareSource Continues to grow county offerings. Alliant Making a new market push in South/North Georgia. Aetna Planning new product development for 2020. Next Steps: Be leery of Pathways terminations. Might just be a county they are leaving. Support diversification, even if to hold Ambetter accountable as well. shpllc.com | 912-691-5711

  25. Whats Next/What Do We Do? COVID-19 State of Georgia: employer based coverage down 9% from February to June 2020. National Expectations are rise in: Medicaid/CMO Health Exchanges Higher Self-Pay Some facilities already seeing a 30-50% increase in self-pay from pre-COVID levels Next Steps: Project volume based on shift in payer mix for internal and HHS reporting purposes. Verify coverage like your life depends on it. shpllc.com | 912-691-5711

  26. Wrap Up & Questions shpllc.com | 912-691-5711

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