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 CMS To Test New Medicare Advantage Supplemental Benefits

Managed care companies under the Medicare Advantage plans will be given “flexibility” to offer patients with chronic diseases supplemental benefits in what federal regulators hope will eventually save public health dollars while not denying elders quality care.
 
Under what regulators are calling the Medicare Advantage “Value-Based Insurance Design Model,” managed care contractors in seven states will be allowed to rejigger health plans for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, strokes, hypertension, coronary artery disease, and mood diseases, the Centers for Medicare &Medicaid Services (CMS) announced late Tuesday.
 
The idea is to encourage health managers to waive co-pays for eye exams for people with diabetes, say, or to offer more help in kicking tobacco addiction for those with bronchial diseases, CMS says in its news release.
 
In addition to developing interventions targeted at all enrollees in one or more of the above categories, participating MA plans will have the flexibility to identify specific combinations of the listed chronic conditions for one or more ‘multiple co-morbidities’ groups and establish tailored" interventions for each group, CMS says in a new fact sheet.
 
“For each of the selected enrollee groups,” CMS’ fact sheet continues, “participating plans may select one or more plan design modifications from a menu of four general approaches. Within each approach, plans have significant flexibility on how (and to what extent) to implement that approach. Plans may vary their proposed interventions from one target population to another, and from one participating plan to another.”
 
The four cost-saving approaches are:
 
1.    For “high-value services,” which would allow plans to eliminate co-pays for necessary, early interventions;
2.    For “high-value providers,” which allow plans to designate specialists, skilled care centers, home health companies, etc. that have demonstrated track records for dealing with chronic diseases;
3.    For “disease management or related programs,” perhaps offered as supplemental benefits if patients meet “certain participation milestones.” (“Examples of interventions within this category include elimination of primary care co-pays for diabetes patients who meet regularly with a case manager and reduction of drug co-pays for patients with heart disease who regularly monitor and report their blood pressure,” CMS says in its fact sheet); and
4.    “Additional supplemental benefits,” which would allow plans to offer supplemental benefits to “specific, targeted populations.”
 
The program will begin test runs in 2017 in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. It “fills an immediate need for testing ways to improve care and reduce costs in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage,” CMS Deputy Administrator and Chief Medical Officer Patrick Conway said in announcing the program.
 
Regulators will be looking for applicants to test the new insurance models soon, CMS says.   
 
Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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