Payers face the logistical challenge of coordinating a network of new, non-medical services to ensure members are referred to the right provider at the right time.
Medicare Advantage (MA) is on track to become a major payer for nonmedical home-based benefits. As care continues to move into the home and community, the trend toward benefits that address social determinants of health (SDOH) will continue.
The payer industry is acknowledging what home care providers have long known: It is possible to reduce costs and improve the quality of care by offering wraparound non-medical benefits such as transportation, durable medical equipment, nutrition services and in-home support.
Since it was first signed into law over 57 years ago, Medicare has experienced significant growth and expansion, including the 1997 implementation of Part C, which granted beneficiaries a wider range of plans offered by private insurance companies.
Better known today as Medicare Advantage, Part C has grown to 28.4 million beneficiaries in 2022, accounting for 48% of the eligible Medicare population, and 55%, or $427 billion, of total federal Medicare spending, according to a recent Kaiser Family Foundation report.
The share of eligible Medicare beneficiaries enrolled in Medicare Advantage programs has more than doubled since 2007, and this year, the Congressional Budget Office projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to 61% by 2032, according to the same report.
Regulatory changes now enable MA plans to offer members nonmedical supplemental benefits, including those that address health-related social needs and SDOH.
For plan year 2023, such services will be offered by 1,091 Medicare Advantage plans, an increase from 729 plans in 2022 in 43 states, Washington, D.C., and Puerto Rico.
Many smaller and regional health plans seeking a competitive edge now offer broader provider networks and are turning to supplemental benefits to entice and retain members.
State Medicaid programs have been innovating for years with long-term support services and benefits covering nutrition, home modification and in-home care support.
CMS tests a host of customized health plan benefit innovations through its MA Value-Based Insurance Design (VBID) Model. The VBID Model, which began in January 2017 and runs through December 2024, is designed to test whether allowing flexibilities in coverage and payment for Medicare Advantage organizations to promote Medicare Advantage health plan innovations would reduce Medicare expenditures, enhance quality of care and improve the coordination and efficiency of care delivery.
In 2023, CMS reports that more than 1,200 MA plans will participate in VBID. Those plans will be a test of the effects of customized benefits designed to better manage chronic conditions and meet a wide range of SDOH, ranging from food insecurity to social isolation.
The most exciting thing about this growth and momentum is that more plans will use supplemental benefit programs to innovate and try new approaches that can move the needle on member wellness.
But activating, coordinating, and measuring the impact of these new services is a challenge. Traditional care coordination is hampered by time-consuming tasks — phone calls, faxes, multiple emails — to identify, activate, and coordinate services. Meanwhile, healthcare providers continue to be plagued by worsening staffing shortages, which only compound the issue.
As a result, health plans are beginning to embrace digital solutions to enable innovative care coordination for their members. When done right, processes are streamlined, care gaps are reduced, and people are happier with the experience.
Here are six steps to start a digital transformation:
1. Evaluate your benefits portfolio. You may want to consider differentiating yourself with new, meaningful types of home-centered services.
2. Use technology to activate partners. Digitally activate your partners in a shared online experience so you have real-time visibility into capacity and availability. This can reduce the time required to align resources to serve members in a timely manner.
3. Empower service coordinators. People involved in coordinating services need to have resources necessary to keep provider information current and organized so they have up-to-date information at their fingertips and can quickly connect people with the right resources at the right time.
4. Make it easy. Service coordinators and in-home service partners should easy to engage, collaborate and create a great experience for members. This can include jointly setting performance goals around member care, encouraging partners to validate outcomes with data, and using shared technology to facilitate communication. Be clear about what information is most important and make it easy for your partners to supply it via automation or simple workflow tools.
5. Evaluate service delivery. Leverage data to determine if partners are meeting commitments on member satisfaction and service delivery. This not only helps with managing the partner network but is essential to improving member experience and supporting VBID requirements.
6. Educate members. Members should know about available benefits and stay connected to determine satisfaction with services.
Improving connectivity is often easier said than done. As more in-home care benefits are offered, the importance of making sure those services are easily accessible will become a measure of quality — and Star ratings. When done right, investing in the technology to manage and coordinate supplemental services can lead to more healthy days at home, higher member satisfaction and, ultimately, higher rates of retention.