Though federal regulators have provided health plans additional flexibility to offer supplemental benefits in Medicare Advantage, uptake of these options has been relatively slow thanks to many operational challenges, a new report shows.
Researchers at the Duke-Margolis Center for Health Policy issued a brief examining the growth of supplemental benefits and the barriers that remain to expansion. They found that the number of plans offering these options has grown since 2019, when the Centers for Medicare & Medicaid Services (CMS) first allowed them to do so.
Between 2019 and 2020, the number of plans offering coverage for adult day care increased from zero to 63, and the number offering in-home support increased from 71 to 148, according to the analysis.
In addition, the number of plans offering non-opioid pain management jumped from 24 to 201 in that same window, and the number of plans covering palliative care doubled from 23 to 58.
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“Where we talked to health plans, we heard a lot of excitement, where plans do seem to be interested in doing more,” Robert Saunders, Ph.D., research director at Duke-Margolis and one of the study’s authors, told FierceHealthcare.
“By and large, we’ve heard a lot interest in exploring what this could look like,” Saunders said.
CMS first allowed plans to dip their toes in the water with supplemental benefits but substantially expanded options in 2020. In the early days of these new options, health plans are learning the ropes through “low hanging fruit” benefits, according to the report.
They’ve also run into several critical hurdles that can hinder these efforts, according to the report. For one, as there was not additional funding set aside for supplemental benefits, payers must be selective in where they deploy them to ensure they’re reaching the beneficiaries that need them most.
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In addition, establishing contracts with community organizations that offer meals, transportation or other benefits poses an organizational hurdle, according to the report.
For example, these groups may not have the appropriate liability insurance and may not have the technology in place to share and receive health data in a way that complies with the Health Insurance Portability and Accountability Act.
"These types of organizations have very different business models and very different cultures, which makes it a little bit challenging,” Saunders said.
Reaching beneficiaries in rural areas also poses a major roadblock, according to the report, as a smaller workforce and limited partnership options make it tougher to provide supplemental benefits in these areas.
Payers are eyeing telemedicine as a solution—for instance, providing palliative care through telehealth—but broadband access in rural areas can be spotty, according to the report.
“Implementation of this type of work turns out to be a bit more complicated than they would have hoped, given the excitement that’s out here,” Saunders said.