SCAN Health Plan expanding Medicare Advantage offerings into Texas
The expansions would bring SCAN's total reach to nearly 7 million potential customers across 20 markets in five states.
Photo: Marko Geber/Getty Images
SCAN Health Plan will expand its Medicare Advantage coverage into Texas beginning in 2023, becoming the latest insurer to increase its foothold in the MA space.
The company is also planning a further expansion in Nevada. Pending regulatory approval from the Centers for Medicare and Medicaid Services, the expansions will bring SCAN's total reach to nearly 7 million potential customers across 20 markets in five states.
Dr. Sachin Jain, president and CEO of SCAN Health Plan and its holding company, SCAN Group, said the company is on a trajectory of rapid growth, thanks in part to a record-breaking Annual Enrollment Period last year.
"We are keenly aware of what older adults are looking for in their Medicare Advantage plan – and we are poised to deliver," said Jain.
WHAT'S THE IMPACT
If approved by CMS, SCAN will expand into Harris County and Bexar County in Texas, as well as grow its existing presence in Nevada into Nye County.
According to Karen Schulte, SCAN's senior vice president of network management, expansion into new markets is largely being driven by invitations from local health systems and medical groups that align with what Schulte calls the company's "member-first approach to care."
"SCAN values building strong, long-standing relationships with its provider partners that translate into improved care for our members," said Schulte. "As SCAN and its reputation continue to grow, it garners the attention of potential partners across the country who align with our mission to keep seniors healthy and independent."
Expansion is a key element of SCAN's major growth and diversification initiatives. SCAN recently made its first-ever acquisition – acquiring The Residentialist Group, renamed Homebase Medical, a medical practice that provides palliative care, chronic disease management, care transition management and in-depth personal health assessments to people in their homes.
THE LARGER TREND
Medicare Advantage plan payments are expected to get an 8.5% revenue increase for 2023, an increase over the 7.98% proposed in the February Advance Notice, CMS said in April. The 2023 growth rate is set at 4.88%, compared with the proposed 4.75% in the 2023 Advance Notice.
MA has been under some scrutiny as of late. Medicare Advantage Organizations sometimes delayed or denied Medicare Advantage beneficiaries access to services, even though the prior authorization requests met Medicare coverage rules, according to an April report by the Office of the Inspector General.
Examples of healthcare services involved in denials that met Medicare coverage rules included advanced imaging services such as MRIs and stays in post-acute facilities such as inpatient rehabilitation facilities.
Meanwhile, as enrollment in the Medicare Advantage program grows, so do concerns and uncertainty over the profits providers are reaping and whether "overpayment" is an issue. A report from the Brookings Institution indicates the five major insurers – UnitedHealthcare, Humana, Aetna, Kaiser Permanente and Elevance Health (formerly Anthem) – are padding their bottom lines by disguising profits as costs.
The report points out that insurers are able to do this because profits accrued through related businesses are not regulated by medical loss ratio requirements.
Still, insurers continue to expand. Clover Health recently did so, with plans to grow into new MA markets in 13 counties across three new states in 2023.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
