- America’s Physician Groups and Partners in Care Foundation are teaming up to offer Medicare Advantage patients new benefits aimed at addressing social determinants of health.
- The recently passed CHRONIC Care Act authorized CMS to provide additional supplemental benefits, including nonmedical benefits, to MA enrollees with chronic diseases. A CMS final rule, released earlier this month, gives MA plans more flexibility in deciding what those benefits will be.
- APG represents nearly 300 managed care medical groups. Partners works with providers, payers and community groups to provide preventive support and social services to adults with complex health issues.
Under the CHRONIC Care Act, supplemental benefits for the chronically ill may include those that “have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits.”
The CMS rule, part of a broad Medicare payment rule for 2019, clarifies that MA can tailor supplemental benefits for chronically ill enrollees to specific medical problems and needs. Effective June 15, the rule paves the way for plans to offer benefits not directly labeled as healthcare, such as ride-hailing services like Uber and Lyft that can help patients get to appointments.
“These new CMS definitions have improved the landscape for all of us and made an increased effort around social determinants of health both necessary and possible,” Donald Crane, CEO of APG, said in announcing the partnership.
The APG-Partners effort is just one of what is likely to be a wave of initiatives aimed at improving health and wellness through nonmedical interventions.
Following the CMS rule, Solera Health announced it was joining forces with Feeding America to help health plans and providers address food insecurity and improve health outcomes. The Phoenix-based integrated benefit network noted adults in food-insecure households are 47% more likely to visit the emergency room and to be admitted to the hospital than people who don’t struggle to eat.