by Paige Minemyer | Jul 25, 2019 3:52pm
It’s crucial that the
rollout of early supplemental benefits in Medicare Advantage (MA) is done
carefully to set a strong foundation to build from.
A new report from
Anne Tumlinson Innovations, the SCAN Foundation and the Long-Term Quality
Alliance aims to help MA plan sponsors implement these new benefits through a
set of guiding principles. The report calls the new benefits a “turning point
in Medicare policy.”
Bruce Chernof,
M.D., president and CEO of the SCAN Foundation,
told FierceHealthcare that Medicare was implemented initially for a
very different demography of seniors than those enrolled in the program today,
so its evolution toward addressing more modern needs like the social
determinants of health must be carefully considered.
“We need this to be successful—it’s good for
people, first and foremost,” Chernof said. “And it lays a predicate
for a larger discussion.”
The Centers for
Medicare & Medicaid Services (CMS) finalized in April its plan to
allow MA plans to cover certain supplemental benefits for
targeted social determinants like air quality and food. The CHRONIC Care Act,
which was passed in 2017, also expanded those options.
Chernof said that
using these early supplemental benefit options effectively paves the way for
further discussions on which should potentially be elevated to a permanent
benefit and which areas should be explored for supplemental benefits in the
future.
“Doing this well
actually helps create a much broader and richer discussion, with data
underneath it,” he said.
The report is built on
four principles:
1. Supplemental benefits must be clear and easy
to understand.
2. They should be equitable.
3. They should be designed in
a manageable and sustainable way.
4. Such benefits should evolve as more data and
experience are gained.
Chernof said a
diverse group of industry stakeholders participated in the discussions that
birthed these guidelines and that having those mixed voices was crucial,
because payers, providers and advocates are all at different points in the
social determinants of health journey and come from different
perspectives.
Aligning these views
also creates a broad coalition that can work together with CMS to discuss
future evolutions of these benefits, he said.
And, once these groups
have a strong knowledge base in using such benefits in MA, the industry can
begin to adapt them more effectively in traditional Medicare or in private
plans, Chernof said.
“The bottom
line is people should care a lot about how this gets launched,”
he said .
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