Although independent evaluations of ongoing demonstrations to integrate care for dual-eligible Medicare-Medicaid beneficiaries are still underway, an April 24 letter from CMS Administrator Seema Verma signaled the agency’s commitment to proving the value of the models as well as testing alternatives.

By Lauren Flynn Kelly

Although independent evaluations of ongoing demonstrations to integrate care for dual-eligible Medicare-Medicaid beneficiaries are still underway, an April 24 letter from CMS Administrator Seema Verma signaled the agency’s commitment to proving the value of the models as well as testing alternatives.

In the letter to state Medicaid directors, CMS extended three new opportunities to “test state-driven approaches” for integrating duals’ care:

(1) For interested states with capitated Financial Alignment Initiative (FAI) model demos, CMS said it is “open to partnering on revisions.”

(2) For interested states without capitated demos, CMS said it welcomes interest in testing the model through new demos in additional states.

(3) CMS said it is open to partnering with states on testing new state-developed models to better serve dual eligibles and invited states to respond with ideas, concept papers and/or proposals.

Kevin Malone, a senior counsel in the Health Care and Life Sciences practice in the Washington, D.C., office of Epstein Becker & Green, P.C. and a former duals officer at CMS, predicts that, for states with existing demos, they will not only revisit their memoranda of understanding that outline the terms of their agreements with CMS, but will use it as a chance to amend their three-way contracts with CMS and plans. This presents a unique opportunity for the plans to suggest changes around certain programmatic requirements or provider training that may reduce some of their burden and streamline some of the technical details of their arrangements.

In the age of value-based contracts and social determinants of health, why shouldn’t plans have an opportunity to serve Medicare Advantage (MA) beneficiaries for longer periods of time and maximize the potential to improve health outcomes and reduce costs?

That’s the question at the center of “Multi-Year Medicare Advantage Plans: A Framework for Action,” a new white paper by consulting firm Leavitt Partners.

By Lauren Flynn Kelly

In the age of value-based contracts and social determinants of health, why shouldn’t plans have an opportunity to serve Medicare Advantage (MA) beneficiaries for longer periods of time and maximize the potential to improve health outcomes and reduce costs?

That’s the question at the center of “Multi-Year Medicare Advantage Plans: A Framework for Action,” a new white paper by consulting firm Leavitt Partners.

Under the MyMAP demonstration project proposed in the paper, MA insurers would be able to offer a multiyear product to beneficiaries with certain high-cost chronic disease needs or high-cost acute medical episodes and test the hypothesis that making “upfront investments” would be recovered over a multiyear period because they produced better care management and better outcomes for beneficiaries.

The authors recommended a contract period of at least three years between health plan and member. To incentivize members to enroll in a multiyear plan, the MyMAP framework suggested that plans could focus on attractive benefits and cost-sharing. Moreover, it might be possible for insurers to guarantee beneficiaries $0 premiums across multiple years of the model, they added.

Moving forward, “the idea will be acted on with specifics,” says former Utah Governor and HHS Secretary Mike Leavitt. He adds that the firm is working with two organizations that are not yet prepared to go public and that focus on certain conditions that would fit well within the framework.

“Multiyear contracting deserves further thought — perhaps as a demonstration,” says Michael Adelberg, a principal with Faegre Baker Daniels Consulting and a former top CMS MA official. “If beneficiaries are locked in, that begs the question of whether plan benefits, networks, service areas also will be locked in.”

With the April 5 release of the Calendar Year 2020 Medicare Advantage and Part D Flexibility Final Rule that implements many provisions of the Bipartisan Budget Act of 2018, MA organizations may offer telehealth services on a scale that’s never been allowed before.

Under the final rule, MA plans starting in 2020 will be able to offer as part of the basic benefit package “additional telehealth benefits” beyond what is available to Medicare fee-for-service beneficiaries and to include more telehealth services in their basic benefit bid paid by the capitation rate.

By Lauren Flynn Kelly

With the April 5 release of the Calendar Year 2020 Medicare Advantage and Part D Flexibility Final Rule that implements many provisions of the Bipartisan Budget Act of 2018, MA organizations may offer telehealth services on a scale that’s never been allowed before.

Under the final rule, MA plans starting in 2020 will be able to offer as part of the basic benefit package “additional telehealth benefits” beyond what is available to Medicare fee-for-service beneficiaries and to include more telehealth services in their basic benefit bid paid by the capitation rate.

CMS also finalized a requirement that if an MA plan covers a Part B service as an additional telehealth benefit, it must also provide access to such a service through an in-person visit and not only through “electronic exchange.”

“I think this is going to be a positive impact from a health plan perspective and I think this is something that health plans wanted CMS to implement for a while,” remarks Brian Collender, specialist leader in the health actuarial practice of Deloitte Consulting. For those larger MA plans that already have telehealth relationships set up with national vendors, expanding telehealth is a low cost/low risk opportunity, he says. Smaller health plans, meanwhile, may not have the capabilities to offer telehealth as a benefit right away, but have options when it comes to vendors that specialize in telehealth.

Moreover, “by reclassifying telehealth services as Medicare-covered under Parts A and B, MA plans can offer telehealth without using up precious rebate dollars that fund supplemental benefits,” says Michael Adelberg, a principal with Faegre Baker Daniels Consulting and a former top CMS MA official.