New MA Flexibilities and Models Pose Both Opportunities and Challenges

By Lauren Flynn Kelly

Managed care experts speaking at the Medicare Advantage Summit 2019, hosted by the Better Medicare Alliance in Washington, D.C., expressed great enthusiasm for new benefit flexibilities and models being offered by CMS, but agreed that there are numerous challenges and unknowns that may complicate MA organizations’ ability to fully embrace such innovations at this time.

New flexibility around supplemental benefits was by far the most discussed topic, but it presents implementation challenges and a need for more research, observed Robert Saunders, research director with the Duke-Margolis Center for Health Policy.

Emerging benefits such as meal delivery may require contracting with multiple community-based organizations. For a statewide or national plan, "that can mean several [full-time employees] just to manage the contracting, let alone actually delivering the services," he said.

Moreover, plans aren't working with a "whole new pot of money" but instead must consider how to use existing dollars more effectively to offer new supplemental benefits and therefore "probably won't end up offering more than a handful at a time."

That's why experimentation as this stage is imperative, weighed in Jennifer Callahan, head of Medicare product development with Aetna Inc. The insurer last year piloted a nutrition benefit that empowers trained Meals on Wheels volunteers to make critical observations while in a patient's home and report changes in condition through an app.

Meanwhile, CMS in reinterpreting the definition of health-related supplemental benefits also gave a new take on MA benefit uniformity requirements, allowing MA plans to offer targeted benefits to certain enrollees starting in 2019. And the 2020 Call Letter established a category of Special Supplemental Benefits for the Chronically Ill (SSBCI) through which MAOs may offer a "non-primarily health related" item or service to chronically ill enrollees.

But Nicholas Johnson, a principal and consulting actuary with Milliman, pointed out that "the SSBCI is specifically supposed to be targeted toward members with chronic conditions, so already you're limiting yourself and you have to define those chronic conditions beforehand."

From RADAR on Medicare Advantage