A new study from the Duke Margolis Center for Health Policy looks at early trends on Medicare Advantage (MA) offerings of supplemental benefits for patient populations with serious illnesses. Among the findings: Only a small number of plans have added new benefits in the first two years that the Centers for Medicare & Medicaid Services (CMS) has provided MA plans the flexibility to offer members new benefits outside of traditional medical services. The report looks at the barriers to implementation and strategies to promote greater adoption.
The research brief examines the growth of supplemental benefits aimed at helping plan members with chronic conditions.
To assess how MA plans reacted to the new flexibilities for supplemental benefits, researchers analyzed plan benefit package (PBP data) published by CMS from 2015 through the first quarter of the 2020 contract year. The team only focused on supplemental benefits that were most relevant to people with serious illness and were allowable per the 2019 and 2020 regulations. In addition, researchers linked the PBP data to MA enrollment data by plan and county, census data, and CMS data on MA penetration by data. Here is what they learned:
- In 2019, the largest increase was in the number of plans that offered a benefit for caregiver support, with a much smaller number of plans offering palliative care, in-home support services, and non-opioid pain management, and no plans offering adult day care.
- By 2020, there was an estimated 80 percent decrease in the number of plans offering caregiver support, but the decline was attributed to one large national insurer that dropped the caregiver support benefit from its plans.
- There were significant increases from 2019 to 2020 in benefits that more directly address the needs of members with serious illness, including adult day health services, palliative care, non-opioid pain management, and in-home support services.
- Supplemental benefits aimed at serious illness care are more likely to be offered in more urban counties.
- New supplemental benefits for serious illness were more likely to be offered in regions of the country where higher proportions of Medicare beneficiaries were enrolled in MA plans.
Barriers to implementation
Researchers interviewed MA plan leaders to learn about their early implementation experiences and identified four challenges:
Lack of funding
The new regulatory flexibility doesn’t include new funding for plans to offer these benefits. Plan leaders told the researchers that they can only offer a small number of supplemental benefits, and that these additional new benefits may mean tradeoffs with other potential offerings, such as dental services, hearings aids and wellness programs that MA plans typically offer. Some MA plans may be able to pay for the new supplemental benefits if they receive Star ratings bonuses or receive rebates if their bids are below the benchmark that CMS set for their local area.
Contracting with community-based organizations
Leaders cited challenges with contracting with community-based organizations that may be able to deliver non-medical supplemental benefits, such as meal delivery, transportation and respite care. Although these organizations may provide these services, they don’t necessarily have experience and the capacity to partner with health insurance plans. In some cases, plans may not be able to contract with enough organizations to cover members across their service areas.
Access barriers in rural communities
Rural communities face many obstacles to care: a smaller workforce, fewer community-based organizations, and long travel times to deliver or receive services. Telemedicine may help ease these burdens, but health plan leaders told researchers that the technology remains under development and many rural areas have poor broadband access. They said it would help if CMS and states issued more standardized telemedicine requirements so they could assess how to leverage the technology.
Aligning benefits across business lines
Some of the leaders interviewed said they didn’t want to create a social determinants strategy for their MA lines of business, using supplemental benefits to deliver nonmedical services that was separate from their company’s other lines of business. They want a common approach across the lines of businesses. However, other leaders told researchers that the MA market was fundamentally different from other lines of businesses and there was no way to align them.
Strategies to help overcome barriers and expand offerings
Most plans pilot new benefits to evaluate their costs and whether they will be successful. Researchers believe that as plans gain more experience with these pilot programs, they’ll be able to draw on data and offer supplemental benefits for serious illnesses across more MA products.
In addition, the research team said CMS can help plans by providing more insight into policy strategy and the objectives driving various programs and changes. Plans need more examples of what CMS expects from them, the report noted. “CMS can help promote evidence for what works and more clearly define what is possible,” researchers concluded.