Medicare Advantage (MA) supplemental benefits have expanded and evolved over the last five or six years, but there’s a need to concretely prove their value. One way to do so would be by mirroring the regulatory model state Medicaid programs use for home- and community-based services.
That’s one of the key takeaways from a report conducted by Leavitt Partners, in collaboration with The Helper Bees.
Overall, over 30 million Americans are enrolled in MA plans. One of main draws of MA is the additional benefits.
Supplemental benefits are different across various plans, but typically include things like dental coverage, fitness and wellness programs, transportation services, and in-home support services, for example.
Over the years, MA supplemental benefits have expanded from a limited set of offerings to a much more ample range of benefits. Some plans have invested heavily in these benefits, while others have shied away.
“By offering a wider variety of supplemental benefits, MA plans have provided numerous seniors with personalized benefits that give them access to the services they need to live a healthier and happier life,” Leavitt Partners wrote in the report. “It has also empowered plans with the flexibility to tailor their offerings to best help members manage chronic conditions.”
The report noted that supplemental benefits have the possibility to drive value-based care. However, MA supplemental benefits need to be assessed to measure their impact. .
“Looking more broadly, the advantages and disadvantages of different MA supplemental benefit approaches are unclear given a lack of standardized data,” Leavitt Partners wrote. “The dearth of comparable data has led to little insight into what plans are offering, what beneficiaries are using, the quality of each provider of supplemental benefits, the level of variability in quality, plans’ success at overseeing these non-clinical service providers and the benefits offered, and the return on investment for the federal government.”
The report suggests that the Medicaid model is the answer.
“Medicare Advantage plans are beginning to see that it is a model that has stood the test of time, and proved reliable for getting these important services fulfilled and developed,” Andrew Friedell, COO of The Helper Bees, told Home Health Care News.
MA plans shouldn’t be scared off from offering in-home support due to the backlash the 1099 model received last year, Friedell added.
“Medicare Advantage plans were early in understanding and embracing the value of in-home support, but they came at it through a relatively new approach with the contractor — 1099 — model,” he said. “[Medicaid] has always kind of relied on that regulated agency model that the states have kind of set up around caregivers entering the home. That gives you all the protections of that state regulated model, like oversight, training and background checks and screening. It also gives you access to a broader spectrum of service options. It isn’t just companionship, but it can also be homemaker services and personal care services.”
Additionally, home care agencies could have the chance to lean into MA opportunities further if there was better data surrounding benefits.
“There are more of these hours being approved, and now they’re also being more concentrated towards that agency approach, that regulated agency framework, which is a good thing for [home care leaders] who run regulated agencies to contemplate if this a space that provides a market opportunity for them in the future,” Friedell said.
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