This year the Centers for Medicare and Medicaid Services (CMS) announced that plans now can offer certain non-traditional benefits as part of their plan offerings moving forward. This was coupled with the ability to vary benefits and services to sub-populations based on disease states and conditions (which is also being experimented with through the Value Based Insurance Design, slated to go to 50% of states in 2019).
While many plans missed the deadline to introduce the non-traditional benefits for 2019, a sizeable number of plans have begun offering these benefits to members. Nearly 270 Medicare Advantage plans will provide an estimated 1.5 million enrollees these new types of supplemental benefits. We believe the benefits will most certainly improve quality but has the potential to have a major impact on the cost spiral the nation is seeing tied to the aging of America. Indeed, CMS’ rationale is that these benefits will compensate for physical impairments, reduce the severity of health conditions, as well as avoidable emergency room and inpatient admissions, among others.
In 2016, we laid out a road map related to how we would impact the aging cost crunch. See the still-relevant blog here. We see the changes proposed by CMS as an additional element. It is a chance to give seniors the resources they need to maintain themselves in their homes and communities and avoid costly higher levels of long-term care.
Plans have had the ability to offer supplemental benefits, such as dental, vision, hearing, meals, non-emergency medical transportation, and over-the-counter products. But the new rule offers far greater latitude. What might some benefits that help with long-term care look like?
- Expanded meals service for those with a lack of food security
- Expanded transportation offerings
- Home improvements and assistive devices to ensure home safety
- Personal attendant, aide and in-home caregiver services
Beyond addressing ongoing clinical needs for disease states and conditions, we know that three things tend to predict senior well-being and longevity. First, medication management is essential. While the services are initially non-clinical, it seems to us that the in-home caregiver services will positively impact this area. It may also help CMS expand the program to limited chronic nursing services in the future. Second, healthy eating is also key. The meals, transportation, and attendant services help here, too. Third, socialization is everything. The expanded services whether it’s the Meals on Wheels coordinator or in-home help, will engage seniors and motivate them. These look-ins can help alert plans to deterioration in physical health.
Overall, the experiment should reap huge rewards over time in member satisfaction, quality, and avoided costs.