By LISA EISENHAUER
The addition of supplemental benefits such as adult day care and caregiver support for Medicare Advantage enrollees is off to a slow start, according to a recent study.
Meyers
The study was done in mid-2019 by David Meyers and others in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health using data from the Centers for Medicare & Medicaid Services. Meyers discussed its findings Nov. 22 during a webinar called "Understanding Opportunities and Barriers to Launching Social Care Initiatives in Medicare Advantage Plans" hosted by the Social Interventions Research & Evaluation Network based at the University of California San Francisco.
The private insurers that contract with the federal government to offer Medicare Advantage plans got the nod in 2018 from CMS to begin providing supplemental benefits starting the following year. Previously, all benefits had to directly prevent or treat an illness.
The rule change makes it possible for the plans to cover nonmedical services that meet social needs related to health, such as adult day care and caregiver support.
Under the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act passed in 2018, even more benefits can be added for enrollees who are chronically ill starting this year. Those benefits can include meals, pest control and transportation for nonmedical needs.
Meyers said that of the 4,660 Medicare Advantage plans with 21.9 million enrollees in 2019, the CMS data showed the supplemental benefit most widely added was caregiver support, such as training or respite programs. The researchers found that 9.2% of plans added the benefit. The second most widely adopted program, added to 3.4% of plans, was in-home support, such as paying aides to help enrollees perform basic tasks like showering and preparing meals.
Other benefits, including adult day care, home-based palliative care and non-opioid pain management, were added to less than 2% of the plans, according to the CMS data.
More insurers said they would offer supplemental benefits this year, although at least one of them that offers several Medicare Advantage plans said it would be dropping caregiver support, the study found.
As to the wider benefits that could be offered this year under the CHRONIC Care Act, several insurers said they would offer transportation for nonmedical needs, but few said they would offer any of the other options, Meyers' team found.
Overall, the study found that the plans most likely to offer the supplemental benefits were those that were larger, older, for-profit and HMO-style and those with the higher performance ratings from Medicare.
Meyers said the CMS data didn't shed light on why plans were or weren't expanding benefits; but, he speculated, "It may take plans additional time to be able to incorporate these into their benefit packages."
Researchers at Brown University did a separate survey of 38 managers with 17 Medicare Advantage plans offered in various parts of the country. Its goal was to understand plan representatives' perspectives on the importance of addressing social needs and their views on the passage of the CHRONIC Care Act.
The survey found that the managers thought "social needs are important and should be addressed." But it also found that their approaches to addressing those needs are distinctly different. Some were interested in creating new, supplemental benefits while others preferred to support community-based organizations to address enrollees' needs.
The survey concluded that changes in Medicare Advantage plans' benefit packages in response to the CHRONIC Care Act "will likely be modest."
Shields-Zeeman
The webinar presenters also discussed a second similar survey done by researchers at University of California San Francisco. The survey was of 25 members of executive leadership teams with 14 Medicare Advantage plans, some of them nonprofit and some for-profit. It focused on how the executives were leveraging the new opportunities to provide social care benefits.
The survey found that mission and values were a stronger driver among the executives than return on investment when it came to embracing the expanded benefits. Researcher Laura Shields-Zeeman said executives from for-profit and nonprofit plans shared similar views on the benefits. Each said, for example, they were happy about the flexibility the new CMS rules provided but also found it challenging to expand their benefits because of limited resources.