More benefits are coming to Medicare Advantage (MA) plans aimed at keeping older Americans in their homes longer, but the uncertainty around these additions—and their cost—means more scrutiny may be needed, according to the Bipartisan Policy Center.
Additional supplemental benefits for MA plans were included in the Bipartisan Budget Act of 2018 and were outlined in a final rule from CMS, with new perks for enrollees that would aid in day-to-day activities, including dressing and bathing.
“This new flexibility for health plans has significant potential to provide access to non-medical health-related benefits, including those that have proved successful in keeping patients in their homes,” reads a brief from the Bipartisan Policy Center, a Washington, D.C.-based think tank.
The benefits can also pay for enrollees to make small home modifications to avoid institutional care, such as changes to accommodate walkers or wheelchairs, and even home-delivered meals.
Some of these benefits help take care of complex patients who need long-term care at home, which can also make paying for the benefits complex, as full accomplishment of the goals of the new benefits may be less clear. Under the Bipartisan Budget Act, the HHS secretary has the discretion on how and if to implement certain provisions of the law, the Center said. CMS should collect data on the return on investment of providing non-medical benefits, the center urged in its brief.
The changes give MA plans more flexibility to lure in enrollees and provide benefits that not only address healthcare needs, but also social determinants of health that are increasingly linked to overall costs. Regulations as well as agencies themselves can actually be impediments and “significant barriers” to transformation of care for adults with complex care needs, the center noted.
Dual-eligible patients—those who qualify for both Medicare and Medicaid—in particular have higher chronic care needs than other patient groups. The new benefits are targeted toward adults with chronic and complex care needs.
However, regulators should be wary that MA plans could tailor the benefits to bring in healthier patients only, by selecting or avoiding risk, according to the Center. CMS should consider prohibiting plans from marketing supplemental benefits, which can influence risk selection.
When accommodating dual-eligibles, CMS should also “draw on lessons from existing care models and demonstrations underway,” particularly to address chronic care needs.
The ideal is to strike a balance between the flexibility that MA plans need to provide services beyond traditional fee-for-service care and ensuring that plans are providing evidence-based care that is integrated, including non-medical supplemental benefits. CMS will also need to provide an appropriate level of guidance when it comes to the flexibility of the non-medical supplemental benefits so plans are not in fear of being audited.