Dive Brief:
-
Changes made to Medicare Advantage under the Bipartisan Budget Act of 2018 will need to balance providing MA plans flexibility to create supplemental benefits while giving adequate oversight over those offerings, according to the Bipartisan Policy Center.
-
The report suggested CMS needs to collect data to gauge the effectiveness of new benefit flexibility, especially because of questions about ROI for non-medical supplemental services.
-
CMS will also need to make sure that plans with supplemental benefits don't cherry pick members and avoid potential risk, the think tank said.
Dive Insight:
Payers have increasingly turned to MA as a growth business. It makes up about one-third of Medicare membership and is expected to grow even more in coming years. However, insurers are still trying to get a handle on costs associated with chronic illness and end-of-life care. Medicare beneficiaries with at least four chronic conditions account for 90% of Medicare hospital readmissions and 74% of overall Medicare spending.
One way to bend that cost curve is by integrating population health programs into MA plans.
Under the law signed in February, MA plans will be able to provide additional or supplemental services to members with complex care needs. That could include help with daily activities, such as bathing and dressing. MA plans could provide payments for services like home modifications and delivered meals starting in 2020.
CMS issued a final rule in May that offered a glimpse into how MA plans can use this flexibility. Advocates hope the loosening of regulations will let payers target social determinants of health such as food security, housing affordability and transportation access. It also has the potential to keep chronically ill people out of emergency rooms and hospitals.
The law gives leeway for the HHS secretary to decide on specifics, with CMS serving as the lead agency. Until HHS and CMS develop a specific plan, it's unclear what these changes will entail exactly, but the idea is to improve chronic care while reducing hospital-related costs.
BPC said multiple questions remain for CMS, such as how it will define and determine care integration, whether more than one plan can coordinate an integrated benefit and how the agency will handle plans that don't integrate.
The report also suggested CMS consider a payer's experience in the private sector for these types of programs. The agency should additionally consider "existing beneficiary relationships with plans and providers" in the areas of Medicare and Medicaid integration.
CMS should look at more meaningful shared savings to get states to improve care coordination for dual-eligible members. The agency must also "draw on lessons learned from existing care models and demonstrations underway through the financial alignment initiative," according to the paper.