Ahead of 2023 Rate Setting, BMA Issues End-of-Year Wish List

by Lauren Flynn Kelly

 

As CMS gets ready to set Medicare Advantage rates for the 2023 calendar year, the Better Medicare Alliance in a Dec. 6 letter urged Administrator Chiquita Brooks-LaSure to take several actions to address social determinants of health (SDOH) and close the gap on longstanding racial disparities. The research and advocacy group supports more than 170 ally organizations that include several major MA insurers.

Among its recommendations, BMA asked that CMS:

• Ensure MA organizations can continue offering robust supplemental benefits by, for example, making changes to the Medicare Plan Finder (MPF), such as standardizing the formatting and language for supplemental benefit offerings.
• Strengthen and expand the Value-Based Insurance Design model by allowing additional MA plans (e.g., Employer Group Waiver Plans) to participate, and ultimately making those VBID flexibilities permanent.
• Modify the star quality ratings program to account for social risk factors that impact health outcomes, such as low income and being a racial-and-ethnic minority. For example, CMS could add measures that reflect beneficiaries’ experience with how their social needs were addressed or adopt the Health Equity Summary Score.
• Strengthen the guidance and establish standards and processes for the collection of race, ethnicity, gender and additional SDOH information in partnership with stakeholders. “More robust, standardized data collection is key to identifying beneficiaries with social risk factors which, in turn, can help plans tailor interventions to address social and medical needs thereby improving health equity for Medicare Advantage’s most at-risk seniors,” asserts BMA President and CEO Mary Beth Donahue in a statement emailed to AIS Health.
• Promote the use of Z codes to identify beneficiary social needs. According to an analysis of the most recently available Z code data, NORC at the University of Chicago found that just 1.3% of all Medicare beneficiaries had their social needs tracked with a Z code in 2018. “Incentivizing providers to use Z codes with trainings, guidance on follow-up referrals, and possible financial incentives will help in identifying beneficiaries that could benefit from additional non-health related services,” suggested BMA.
• Ensure that high-quality health risk assessments are being conducted in members’ homes by codifying the best practices proposed in the 2016 rate notice and final call letter for in-home HRAs, establishing guidelines for follow-up care after an in-home HRA and developing enhanced screening for social risk factors as part of the assessment.

From Radar on Medicare Advantage

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