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Aetna reports rising admissions and higher pharmacy/inpatient costs in Medicare Advantage book
Summary
Aetna told the Commission that Medicare Advantage utilization rose (12.8% increase in admissions per 1,000) and that pharmacy and inpatient costs are major drivers of a 9.5% increase in total medical/pharmacy costs for the reporting period; telehealth paid amounts rose while visits fell.
Aetna presented the quarterly Medicare Advantage report for 9,156 members and highlighted utilization changes: average member age 75.6, a 12.8% increase in admissions per 1,000 and a 25.7% increase in non‑acute admissions per 1,000 compared with the prior year period. The vendor said total medical/pharmacy costs increased 9.5% and noted pharmacy and inpatient costs as principal contributors.
Aetna also reported 288 high‑cost claimants (defined as $75,000+), an 18.8% increase over the prior period, and a rise in average high‑cost claimant expense ($139,614). Telehealth paid amount rose by 5.1% even as the number of visits decreased; paid per telehealth visit increased 9.2% (from $107 to $117). Commissioners asked why non‑acute admissions rose; Anthem agreed to follow up to investigate possible links, including this season’s flu vaccine effectiveness.
