RISE summarizes recent news in the Medicare Advantage (MA) space.

NORC report: MA dual eligible faced fewer COVID-related disruptions in care

Dual eligible beneficiaries enrolled in MA were less likely to experience disruptions in their health care during the COVID-19 pandemic than dual eligibles enrolled in traditional fee-for-service (FFS) Medicare, according to new analysis from NORC at the University of Chicago.

Despite being older and sicker, dual eligibles in MA were less likely to report difficulty accessing care during the COVID-19 pandemic. Only 35 percent of dual eligibles in MA said they were unable to get a regular check-up during the pandemic, compared to 51 percent in FFS, according to the report. Similarly, dual eligibles in MA were less likely to report that they were unable to get diagnostic or medical screening tests, treatment for ongoing conditions, and urgent care for accidents or illnesses during the pandemic.

“Medicare Advantage dual eligibles experienced fewer disruptions in care during the pandemic, which may be the result of added care coordination and outreach from their health plans,” Caroline Pearson, senior vice president at NORC at the University of Chicago, said in the announcement. “Older adults often select Medicare Advantage plans due to expanded benefits and lower out-of-pocket costs. But especially during a pandemic, navigation and care coordination services are critical to help close gaps in care.”

Twenty six percent of dual eligibles who chose MA are age 75 or older, compared to 18 percent of dual eligibles enrolled in FFS. Dual eligibles in MA were more likely to be Black and/or Hispanic, and more likely to speak a language other than English at home. Further, 56 percent of dual eligibles who chose MA have four or more chronic conditions, compared to only 47 percent of those in FFS.

“In recent years, Medicare Advantage plans have increasingly enrolled more complex and medically frail members,” Mairin Mancino, senior director of health dare strategy at NORC at the University of Chicago, said in the announcement. “Older adults with higher medical needs can benefit greatly from improved care management and coordination of services that Medicare Advantage plans provide.”

SCAN Health Plan launches unique program to reduce loneliness among seniors

SCAN Health Plan, one of the nation’s largest not-for-profit MA plans, announced this week the launch of its new “Togetherness Program” to combat loneliness among its membership. The program will rely on senior-to-senior interactions to reduce isolation.

Even before the pandemic, more than 40 percent of older American adults reported feeling lonely on a regular basis. Since March of 2020, social distancing requirements as well as high death rates among older adults have left seniors feeling alone and starved for human companionship. One in four adults ages 65 and older reported anxiety or depression during the pandemic—up dramatically from pre-pandemic levels.

“We’ve got members who haven’t hugged another person in more than a year,” Lisbeth Briones-Roberts, who is overseeing SCAN’s program as the organization’s new chief togetherness officer, said in the announcement. “We know they need our help reconnecting with people and rediscovering shared meaning with others who can relate to and have a unique understanding of their personal experiences.”

SCAN’s program is grounded in peer-to-peer interactions—which have long been the hallmark of SCAN’s care model. Since 2016, peer advocates, who are SCAN members as well as SCAN employees, have regularly reached out to plan members to discuss common issues of aging, connect them to community resources, and support them in navigating the health care system.

“We know that our peer advocates have helped thousands of SCAN members live healthier, more independent lives by seeking treatment for some of the most common ailments affecting seniors,” said Briones-Roberts. “So, we’re building on what we know works and using our experience and expertise to improve health outcomes related to loneliness and social isolation.”

The Togetherness Program will feature:

  • Virtual and in-person classes and activities based around shared interests
  • “Friendly Phoner,” a program through which peer advocates and SCAN employee volunteers will regularly reach out to members by telephone
  • “Tech Buddy,” support for people who want to use tablets and other digital devices to connect with other people

Bipartisan bill aims to revamp MA prior authorization

House representatives from both sides of the aisle have introduced legislation to streamline and standardize the way MA plans use prior authorization. The Improving Seniors’ Timely Access to Care Act would:

  • Establish an electronic prior authorization process
  • Require the Department of Health & Human Services to establish a process for “real-time decisions” for items and services that are routinely approved
  • Improve transparency by requiring MA plans to report to Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials
  • Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians

“When seniors need critical medical care, doctors and other health care providers should be spending their time working with patients instead of going back and forth on requests that should be electronic, standardized, and eventually automated,” said Rep. Susan DelBene (D-Wash.), one of the co-sponsors of the legislation, in an announcement. “The majority of the health care community agrees that prior authorization needs to be reformed. This bipartisan legislation creates sensible rules for the road and will offer transparency and oversight to the prior authorization process.”

Forbes: More companies plan to expand their MA footprint through mergers, acquisitions

A recent article by Forbes examines the growing number of insurers looking to increase their MA business via acquisitions. This week Zing Health Enterprises announced it would broaden its geographical footprint by launching MA plans into 32 additional states and the District of Columbia via the planned acquisition of Lasso Healthcare Insurance Co. Forbes also noted that Alignment Healthcare intends to use mergers and acquisitions to enter new markets as do larger for-profit players, including UnitedHealth Group, Humana, Cigna, and Anthem. MA enrollment has nearly doubled over the last decade as more companies offer plans throughout the country. In 2021, Medicare beneficiaries have access to more than 4,800 MA plans, an increase of 2,100 from 2017.