The end of the public health emergency could eliminate telehealth access for many socioeconomically disadvantaged Medicare patients.

The “never growing old” generation now faces retirement, a host of chronic health conditions, and mortality. The pandemic sparked a major shift toward digital channels to find health information, assess providers, and research Medicare plans and options.

A new OIG report details how Medicare Advantage members are far more likely to conduct a home healthcare visit with a provider they don't have a relationship with—good news for startups like Dispatch Health and Heal.

The health system reported that less than a year into the program, its 30-day readmission rate dropped from 16% to 6% among its high-risk Medicare patients. Expanding access to care. The Mayo Clinic adapted its remote chronic care program during the pandemic to monitor lower-risk COVID-19 patients.

MA plans are growing in popularity for beneficiaries because they often come with extra benefits over original Medicare, such as vision, hearing, dental, and wellness programs. 42% of all Medicare beneficiaries—more than 26 million people—are enrolled in MA plans, a rate that has steadily increased over the past decade, according to the Kaiser Family Foundation (KFF).

This is a massive problem for older US residents as the Medicare population explodes. The CMS projects Medicare enrollment will increase to 80 million beneficiaries by 2030, up from 54 million in 2015. The big takeaway: Even though competitors like Humana have made major headway in the home healthcare space, UHG is still on track to dominate every corner of the healthcare industry.

For example, last December, the tech giant unveiled a new Google Search feature that makes it easier for patients to find doctors that accept Medicare. Many Medicare Advantage (MA) patients are willing to see doctors they haven’t had a visit with yet. Only 29% of MA members knew their home health clinician prior to the visit, per an October 2021 OIG analysis of 26 million beneficiaries.

Medicare will soon pay eligible providers and organizations to offer free COVID-19 tests to Medicare patients, which could present a huge revenue opportunity for telehealth/at-home testing vendors. For context, free over-the-counter rapid COVID-19 tests will be offered to the 60 million Medicare beneficiaries starting in the spring, per the CMS.

Insurtechs are focusing on Medicare Advantage (MA) plans. This could contribute to high medical expenses. During Q2’21, MA-focused insurtech Devoted Health spent 101% of its health plan premiums it earned. That’s far higher than the 85% insurers typically spend on premiums to keep some profit, per Insider. What’s next? We could see insurtechs scale back their market presence like Bright Health.

It has been one of few health systems in federal ACO programs that generate savings for Medicare (based on ability to cut costs and improve quality). Advocate Aurora’s ACOs generated $110 million in savings in 2021, which brought its total VBC savings to over $414 million.

The company admitted to dispensing insulin pens that exceeded days-of-supply to avoid Medicaid and Medicare limitations, per the DOJ. That resulted in overbilling the gov’t for insulin shipments between 2014 and 2019. For context, Amazon acquired PillPack in 2018. What this means: The federal gov’t is cracking down on digital pharmacies’ dispensing practices.

In September 2020, it struck a deal with Medicare-focused primary care company Oak Street Health to integrate its primary care services into three major supercenters. In May 2021, Walmart acquired telehealth provider MeMd. This gave Walmart the competitive edge of having both in-person and virtual care services.

As more boomers age into Medicare over the next few years, there will be an influx of Medicare Advantage (MA) members. The number of MA enrollees swelled from over 10 million in 2010 to over 23 million in 2020 alone, per KFF data.

The number of Medicare Advantage plans offering social health-focused benefits increased three-fold over the past year, but their members aren’t using them—we explore how tech from SDOH startups like Papa can boost uptake.

Private payers paid more than five times what Medicare paid for dialysis from 2012 to 2019, according to claims data from Blue Cross Blue Shield.

For context, a stalled piece of legislation (The Build Back Better Act) would cap insulin costs, but only for Medicare patients. Why this matters for the Biden admin: Capping the cost of insulin would help prevent drug prices from continuously rising, a factor that is driving poor medication adherence and contributing to massive healthcare costs for the US.

The retail giant filed paperwork to provide virtual care in 37 states as it decelerates brick-and-mortar expansion plans. We think it could market audio-only visits to its massive Medicare population since pandemic-era coverage for these visits could be permanent.

For example, physicians wouldn’t readily conduct care in a health system metaverse if something like VR “procedures” aren't covered by Medicare plans, since they won’t be getting reimbursed.

That’s probably because older adults have more certainty around insurance coverage because of Medicare, while it can be more variable for adults under private health plans.

This would complement Cigna’s already massive existing member base: Cigna claims it serves over 180 million customer and patient relationships globally across its pharmacy (Express Scripts) and medical business, many of which are US-based Medicare members. Plus, Cigna would become a much larger threat to market leader United Healthcare.

For example, last month, Cigna announced it’s expanding its partnership with digital musculoskeletal care solution RecoveryOne to offer Medicare Advantage (MA) members personalized virtual care to treat conditions like back pain.

The news: Digital musculoskeletal (MSK) treatment company RecoveryOne revealed it’s expanding its partnership with Cigna to offer virtual physical therapy (PT) for Medicare Advantage members within the Tennessee market. More on the Cigna-RecoveryOne partnership: Cigna already offers RecoveryOne’s services to its employer clients—and it’s a longtime investor in the startup.