Medicare Advantage plans could get even more flexibility to address social determinants of health for beneficiaries if Health and Human Services Secretary Alex Azar has his way.
In turn, that could mean even more opportunities for home care providers to offer and be reimbursed for services such as companion care, bathing, transportation and more.
“Our system can often be penny-wise and pound-foolish, spending generously on health care without considering how health could be improved by addressing non-health needs,” Azar said Tuesday during the Medicare Advantage (MA) Summit hosted by the Better Medicare Alliance in Washington, D.C.
But as of late, the government has made attempts to change that by allowing Medicare Advantage plans to cover a variety of non-medical needs. While the cohort of patients who can receive such services remains somewhat limited, that could change, Azar hinted.
“You’ve already seen one effort to address [social determinants] through new supplemental benefits in Medicare Advantage, like home-delivered meals, transportation and home modifications,” he told summit attendees. “We want to go further, and we look forward to working with all of you to think about how best to do that.”
Currently, Medicare Advantage plans can offer supplemental benefits that compensate for physical impairments, lessen the impact of injuries or health conditions or reduce avoidable hospital admissions.
In 2020, they’ll have the flexibility to offer beneficiaries with chronic conditions any supplemental benefit that has a “reasonable expectation” to improve or maintain patient health.
While Azar did not elaborate on the government’s desire to “go further” to address social determinants of health, speakers identified areas of MA opportunity over the course of the summit.
“To me, the biggest gap is that [the 2020 supplemental benefit expansion] is limited to the chronically ill,” Jennifer Callahan, who works in Medicare Product Development at Aetna, said during a separate panel. “There’s acute illness where some of these supplemental benefits would be really incredibly useful [but] that we wouldn’t be able to do unless the member also had a chronic disease.”
If CMS were to expand flexibilities for MA plans to cover a wider subset of patients, home care companies would potentially have even more opportunities.
Meanwhile, Azar also discussed the importance of improving interoperability and kidney care, both of which the Trump administration is attempting to tackle.
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) proposed rules to improve data sharing between health care providers and insurers. It would require the adoption of a secure, standard format for electronic patient data by 2020.
On top of that, federal policymakers proposed a series of new payment models for certain kidney-related conditions earlier this month. Among other things, the new models encourage at-home dialysis, potentially opening up opportunities for home-based care providers down the road.
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