Continued growth, strong performance and new guidelines are good news for plans and their members
By Bill Roth
Already the choice of more than one-third of the 59 million people with Medicare, the Medicare Advantage (MA) program is growing and changing in ways that will help even more seniors maintain good health and independence as they age.
Strength in Numbers
The number of eligible seniors opting for MA plans over fee-for-service Medicare has grown year after year—and shows no signs of slowing down. Medicare managed care plans now provide coverage to more than 21 million people with another 2 million expected to join in 2019. If that happens, MA plan members will represent 39 percent of the total Medicare population. Among the largest MA plans in California, SCAN has witnessed this trend first-hand, increasing market share and experiencing significant growth in Los Angeles, Orange and Sonoma counties during the 2018 annual enrollment period.
Bigger and Better, Too
MA plans improve the health of seniors in ways that other coverage options haven’t, and this is fueling increased enrollment. With a focus on preventive services, care coordination, access and continuous improvement, MA plans continue to outperform fee-for-service Medicare in key quality measures.
A recent study by Avalere Health shows Medicare Advantage beneficiaries had 23 percent fewer inpatient stays, 33 percent fewer emergency room visits and better health outcomes overall than individuals enrolled in FFS Medicare at similar costs to regular Medicare. People with chronic conditions, such as diabetes, in particular benefit from the extra benefits and programs available through Medicare managed care, experiencing better health outcomes and fewer complications, including serious complications, from their conditions.
Findings like these are important for several reasons. For one, they confirm that what providers of MA plans like SCAN and others like us are doing is making a meaningful difference in the lives of members, particularly those who need help the most. They also underscore plan’s commitment to providing high quality benefits and services that meet members’ individual needs related to health and independence. Knowing that MA plan members have better experiences can also be useful to our broker partners, because when you present an MA plan to your clients, you can be confident you are offering them coverage they can rely on for high-quality care, improved access and better health.
When it comes to MA, quality begets even greater quality. Since Medicare pays a bonus to plans demonstrating the highest quality, well-performing plans can reinvest these bonuses, continuously improving benefits, access and quality of care for the member. SCAN’s 4.5 star rating for 2018 from the Centers for Medicare & Medicaid Services is not only a reflection of our efforts to improve quality and services, but an investment that pays off in a meaningful way for us, our provider partners, and our members.
New Laws, New Opportunities
MA’s success in providing high-quality, value-driven and cost-effective care has not been lost on lawmakers. At the federal level, MA plans have earned bi-partisan support, with more than 360 members of Congress pledging to preserve the program. They showed their support in an even more tangible way earlier this year with legislation that will make it possible for plans to further improve services and health outcomes:
- Special Needs Plans, which until now were temporary demonstration projects, can now be offered by MA plans on a permanent basis. This change will allow more of the nation’s frailest seniors to benefit from programs that help them age successfully at home for as long as possible. Health plans that already offer SNPs can begin to think in the long term, while other plans that were put off by the uncertainty of past SNP rules will likely begin exploring these options. The result: More seniors with chronic illnesses and other special needs will have access to programs and services designed to support them.
- The definition of “primarily health-related” supplemental benefits has been expanded to allow MA plans to offer food, counseling and other non-medical services as long as they can help prevent, cure or reduce illness or injury.
- TeleHealth made headlines when the Bipartisan Budget Act was signed into law in February. The legislation allows MA plans to include delivery of telehealth services in a plan’s basic benefits. This can enable a member to access mental health services from the privacy of their own home, or provide a convenient way to ensure post-hospitalization follow-up care is received.
- While plans in the past have been required to offer the same benefits to all their enrollees, new regulations also allow MA plans to tailor benefits to groups within their membership with specific health conditions. For example, a plan could offer all members diagnosed with diabetes additional coverage for podiatry services, offering another way to better tailor plan coverage to member need.
Many MA plans have likely incorporated the new benefit flexibility into 2019 plan bids for approval by Medicare. While 2019 benefits have not been released as of press time, I’m confident that many in our industry are thinking of new and creative ways to provide the most value for members under the new guidelines.
A Strong Choice for Seniors
These “new developments” align with SCAN’s history as a social HMO and our decades of experience caring for the frailest seniors. As a long-time advocate for changes that would allow greater flexibility in meeting seniors’ individual needs, we are excited to be looking at ways to once again provide benefits that can more directly help each member age safely in the setting of their choice.
When evaluating which MA plan is right for each client, think about both the nature of the benefits and the stability of the plan. While it’s exciting to offer “more” and “different” benefits, it’s also imperative that the plan will be there for the long-term. Make sure the plan under consideration is adding benefits and services at prices that are sustainable year over year. While more customized coverage options will only add to MA’s appeal, plan members—your clients—depend on stability of cost and coverage. The plan should work as hard to retain existing clients as it does to gain new ones.
The bottom line is this: 2018 has been a good year for seniors! The many benefits that already come with membership in a Medicare Advantage plan will inevitably get even better.
Bill Roth is the president of SCAN Health Plan and oversees the organization’s operating and financial performance. An accomplished healthcare executive, Roth has more than 20 years of managed care experience with prior roles at CIGNA HealthCare in Connecticut, Aetna, Blue Cross of California and WellPoint. He earned both his Bachelor of Science and Master of Business Administration at Indiana University.