In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, the Better Medicare Alliance proposed strategies to better serve Medicare Advantage (MA) members. The letter was sent as CMS prepares its Calendar Year 2023 MA rate and policy-setting process.
The December 6 letter highlighted recent success of MA, including keeping average monthly premiums at a 15-year low, bringing Star Ratings for 2022 to a record high, delivering fewer hospitalizations and emergency room visits, and enrolling a proportionally more diverse, lower-income population than fee-for-service (FFS) Medicare.
But the organization urged the agency to adopt specific proposals to address social determinants of health (SDoH), close the gap on longstanding racial disparities in health care and ensure high-quality in-home health risk assessments. Those proposals include:
- The adoption of quality measures related to SDoH and modification of existing MA Star rating quality measures to account for social risk factors. Examples could include the addition of a measure that sheds light on the beneficiary’s experience with how their social needs were addressed or the adoption of the Health Equity Summary Score to measure a health plan’s ability to address social risk factors.
- Standardization of the format and language used to discuss supplemental benefit offerings in Medicare Plan Finder. The proposal, which aims to bring greater transparency to supplemental benefit offerings, would also require the disclosure of additional information about supplemental benefits on the site.
- Expansion of the Value-Based Insurance Design (VBID) model: Because the MA-focused demonstration model is the only one currently authored by the Center for Medicare and Medicaid Innovation, BMA suggested building on the program’s track record of success. Policy options include allowing additional MA plans to participate—including Employer Group Waiver Plans–and considering permanent authorization at the end of the demonstration project.
- Codification of best practices for health risk assessments conducting during an in-home clinical visit: In 2015, the Obama administration’s CMS encouraged “plans to adopt, as a best practice, a core set of components for the in-home assessments they perform.” BMA supports codification of best practices that stipulate who can perform in-home clinical assessments, what components must be included, and what processes exist for determining needed follow-up care.