In September, the U.S. Centers for Medicare & Medicaid Services (CMS) released high-level data suggesting a huge expansion of new Medicare Advantage (MA) supplemental benefits for 2021.
CMS followed that up with specific information on MA supplemental benefits under the “primarily health-related” pathway a month later, catching home care providers’ attention due to strong numbers around in-home support services.
Since then, those who follow the MA landscape have been waiting for additional data around another category — the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway.
Those numbers are now in, too, and they’re just as exciting.
“We’re seeing really substantial growth in the number of plans offering Special Supplemental Benefits for the Chronically Ill,” Tyler Cromer, a principal at Washington, D.C.-based research and advisory firm ATI Advisory, told Home Health Care News. “We’re seeing an over 250% increase in the number of plans offering these benefits since 2020, which was the first year they were available.”
Broadly, SSBCI are benefits that can be offered to MA enrollees with one or more complex chronic conditions who are at high risk for hospitalization and other adverse health outcomes. The idea is these individuals often require intensive care coordination, so plans should be able to bring together all sorts of innovative services to keep them healthy and at home.
Overall, the number of MA plans offering SSBCI has increased from 267 plans in 2020 to 942 plans in 2021, according to an ATI Advisory analysis.
Comparatively, the greatest year-over-year growth comes around the “social needs benefit,” Cromer noted.
The wide-ranging benefit can include a variety of services focused on boosting social well-being, including companionship services, something that most home care agencies offer.
“The social needs benefit is probably the least self-explanatory, but that can be memberships in non-health clubs, or social clubs,” Cromer said. “It can be companionship and a number of other things. But the idea is providing social support, particularly during COVID, when we’ve had so many issues related to isolation exacerbated.”
From 2020 to 2021, the number of plans offering the social needs benefit jumped from 34 to 227 — a 568% increase.
Meals, transportation for non-medical needs and services supporting self-direction are also benefits that saw a big increase in plan interest compared to last year, according to ATI Advisory.
“I think there are a few places where home care agencies can really contribute,” Cromer said. “Absolutely on the social needs benefit. I think also, you know, transportation for non-medical needs.”
The general increase in SSBCI is partly driven by large insurers offering related benefits across more of their plans, ATI Advisory explained in its analysis.
But the increase is also linked to smaller and regional players opting to offer SSBCI.
“We’re seeing new entrants, plans and MAOs, or Medicare Advantage organizations, offering these SSBCIs for the very first time,” Cromer said. “Centene (NYSE: CNC) is offering SSBCI for the first time, and they’re coming in with a pretty high number of plans.”
Additionally, it’s important to note that certain SSBCI benefits are now available in at least one plan in every county in the country. In 2021, there is nationwide coverage of both meals and social needs benefits.
“If you had asked me before the data came out what the rate of growth would be, I would not have predicted it would have been quite this high,” Cromer said.
As benefits become more prominent, ATI Advisory hopes to see stakeholders collaborate with one another to share learnings and enhance the availability of SSBCI to better meet the needs of chronically ill enrollees.
To help home care operators with their MA strategies, ATI Advisory offers a 2021 Medicare Advantage Supplemental Benefits State Report. It’s currently in the process of updating that tool with the new SSBCI information, Cromer said.
Congress created SSBCI through the “Creating High-Quality Results and Outcomes Necessary to
Improve Chronic (CHRONIC) Care Act,” enacted as part of the Bipartisan Budget Act of 2018.