After a relatively modest first year, the number of
condition-specific supplemental benefits offered by Medicare Advantage plans
more than doubled from approximately 820 in 2019 to 1,850 this year, according
to a new report from Faegre Drinker Consulting. And, in the first analysis of
new Special Supplemental Benefits for the Chronically Ill (SSBCI) for 2020,
Faegre Drinker found that only 245 plans out of approximately 6,000 MA plans
(including employer-only plans) total offered them. But the firm observed that
adoption of the new "flexible benefits" permitted by CMS may improve
as plans see what works and what doesn't and explore their potential to
increase enrollment, improve outcomes and generate net cost savings.
"We see a big increase in condition-specific benefits in
2020, but the SSBCI uptake was pretty small," remarks Michael Adelberg, a
principal with Faegre Drinker and a former CMS MA official.
Analyzing condition-specific benefit and SSBCI data from CMS,
Faegre Drinker observed that diabetes topped the list of condition-benefit
categories and saw a 150% increase in benefits related to that condition.
Hypertension had the greatest increase (529%) but is still tied to only 5% of
targeted benefit offerings.
While some plans chose to attach certain prerequisites to
condition-specific benefits, 60% had no such requirement.
"The conventional wisdom is that the national plans are way
out in front, but the data tells a more nuanced story," says Adelberg.
"A handful of regional plans are ahead of the nationals on benefit
innovations."
In offering SSBCI, plans for 2020 were given a list of 15
conditions for which they could offer benefits that aren't primarily health
related so long as there is a "reasonable expectation of improving or
maintaining the health or overall function of the chronically ill
enrollee."
But uptake of those benefits by insurers was modest. "In
the long run, we'll see plans with outcome-improving, actuarially solid
condition-specific benefits throughout the MA landscape," predicts
Adelberg. "But it's going to take a while."
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