Medicare

The Medicare Advantage VBID Plan Administrative Challenge

Submitted by Brennan Collins on Fri, 05/11/2018 - 11:15

CMS started its VBID (value-based insurance design) innovation model for Medicare Advantage on January 1, 2017 to run for five years.  
 
Eligible Medicare Advantage plans can offer “varied plan benefit design” for enrollees based on specified clinical categories identified and defined by CMS. In 2017, diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, mood disorders, and combinations of thereof were the defined categories.
 
As reported in Healthcare Finance, CMS chose nine Medicare Advantage organizations to participate in the 2017 value-based insurance design model: Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan of Massachusetts, Tufts Associated Health Plan of Massachusetts; Geisinger Health Plan, Aetna, Independence Blue Cross, Highmark of Pennsylvania, UPMC Health Plan of Pennsylvania; and Indiana University Health Plan. (Blue Cross Blue Shield of Michigan was added in 2018.)
 
With that, according to an analysis by Manatt Phelps & Phillips LLP, there were 45 value-based approaches (aka plan benefit packages, or PBP) being used by the nine Medicare Advantage Organizations (MAO) individual plans.  With 45 PBPs implemented by 9 plans, that suggests that administration could be a challenge for each MAO. 
 

CMS Expands Medicare Diabetes Program

Submitted by Brennan Collins on Wed, 05/09/2018 - 11:50

The Centers for Medicare and Medicaid (CMS) has expanded its Medicare Diabetes Prevention Program (MDPP) to now enroll traditional healthcare providers and community-based organizations as Medicare suppliers of health behavior change services.
 
The  (MDPP) seeks to prevent or delay type 2 diabetes through health behavior changes. MDPP is a structured intervention geared to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. 
 
Key to prevention or delay of any chronic disease is to identify at-risk members earlier and close gaps in care faster. 
 
In working with Medicare plans, we have experienced that the key driving force is to get Medicare Advantage plan members to take clinical actions. We have found that the right incentives can drive these clinical actions to interpret more data to find risks earlier.
 
Some clinical action improvements/success we have encountered in working with Medicare Advantage plans include the following:
 
+40% increase – adult BMI assessment (E/M visit)
+31% increase - in-home assessment
+17% increase - retinal eye exam
+31% increase - kidney disease monitoring
+10% increase - A1c tests 

Uber & Lyft Next in Medicare Plan Choice

Submitted by Rob Wyse on Mon, 05/07/2018 - 11:52

CMS announced that it “finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices.” 
 
While the announcement focuses on prescription drug pricing, the additional plan choices means the agency is “reinterpreting the standards for health-related supplemental benefits.”  CMS will now allow supplemental benefits if they “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

Bruce Japsen of Forbes wrote that Uber and Lyft will likely be included in these benefits to transport seniors to doctors in on-emergency situations.  
 
The precedent has been set for almost 20 years with non-emergency transportation providers like Cleveland-based, Provide A Ride, a van service for Medicaid and Medicare MCO transportation benefit programs.
 
Plus, for Medicare Advantage plans, promoting and contracting new additional plan choices can become a marketable difference for 2019.
 
Additional services Medicare Advantage plans could pay for in 2019 include the following: