From lowering cost sharing on select services to participating in the new Part D insulin model, Medicare Advantage insurers are incorporating new benefit flexibilities into their overall management of diabetes, which impacts one in every three Medicare beneficiaries.

Diabetes accounts for more than $300 billion in U.S. health care spending, including $17 billion spent on insulin in the Part D program. According to a Faegre Drinker analysis, 23.7% of plans offering condition-specific benefits this year are targeting diabetes. The most popular benefits include reduced cost sharing on podiatry, physician specialist and primary care physician services, and additional supplemental benefits related to podiatry, meals and worldwide urgent coverage.

NOTE: The abstract below is a shortened version of the RADAR on Medicare Advantage article “MA Plans Test New Flexibilities Targeted to Diabetic Members.”

By Lauren Flynn Kelly

From lowering cost sharing on select services to participating in the new Part D insulin model, Medicare Advantage insurers are incorporating new benefit flexibilities into their overall management of diabetes, which impacts one in every three Medicare beneficiaries.

Diabetes accounts for more than $300 billion in U.S. health care spending, including $17 billion spent on insulin in the Part D program. According to a Faegre Drinker analysis, 23.7% of plans offering condition-specific benefits this year are targeting diabetes. The most popular benefits include reduced cost sharing on podiatry, physician specialist and primary care physician services, and additional supplemental benefits related to podiatry, meals and worldwide urgent coverage.

And the fact that more than 1,600 MA and Part D plans this year are participating in the CMS Part D Senior Savings Model — which aims to lower out-of-pocket costs for diabetic seniors by featuring predictable copayments of no more than $35 for a broad set of insulins — speaks to plan sponsors’ confidence in serving the diabetes population effectively, suggests Tim Murray, director and senior consulting actuary with Wakely Consulting.

SelectHealth says many of its MA members in Idaho, Nevada and Utah already have $0 cost sharing on several services, but it has incrementally enhanced its diabetes-specific benefits in select markets and observed a “small, yet positive increase in these benefit utilizations.” The insurer focuses on reducing costs associated with essential services that are key to diabetes management, and says it targets behaviors as opposed to looking at the severity of the disease or risk scores when considering benefit design.

Blue Cross & Blue Shield of Rhode Island (BCBSRI) offers multiple flex benefits for members with diabetes, including routine foot care and additional dental services. That’s all part of a whole-person approach that includes education and ongoing clinical coaching and management, explains Michael Menard, managing director of Medicare strategy, product and business operations. New for 2021, BCBSRI is also participating in the Part D insulin model.

MVP Health Care, which sells MA plans in New York and Vermont, says it has offered many low- and no-cost services related to diabetes for several years, and for 2021 has removed the cost of routine podiatry care.

Independence Blue Cross has also made incremental adjustments to its diabetes-specific programs, including the expansion of a post-discharge meal benefit, the addition of a medical nutrition therapy benefit, and a dedicated diabetes case and condition management program to improve utilization and reduce gaps in care.

With reports of low Medicare Advantage switching during the recent Annual Election Period (AEP) and major national carriers capturing two-thirds of new enrollment, smaller regional players are looking at the current Open Enrollment Period (OEP) as an opportunity to foster satisfaction and retention and to promote their brand through multiple marketing channels.

“Even before the end of AEP, we were planning with our regional clients to ensure they had a strong presence in the marketplace during the OEP,” says Renee Mezzanotte, executive vice president of client engagement with Chesterbrook, Pa.-based DMW Direct. “A combination of media channels — digital, direct response TV and direct mail — are proving to keep our clients top of mind. As in years past, to make the most of limited budgets, DRTV schedules are flighted around direct mail drops to boost awareness and response. We can’t outspend national players, but we can outsmart them.”

NOTE: The abstract below is a shortened version of the RADAR on Medicare Advantage article “OEP Tactics Include COVID Comms, Direct Plan Comparisons.”

By Lauren Flynn Kelly

With reports of low Medicare Advantage switching during the recent Annual Election Period (AEP) and major national carriers capturing two-thirds of new enrollment, smaller regional players are looking at the current Open Enrollment Period (OEP) as an opportunity to foster satisfaction and retention and to promote their brand through multiple marketing channels.

“Even before the end of AEP, we were planning with our regional clients to ensure they had a strong presence in the marketplace during the OEP,” says Renee Mezzanotte, executive vice president of client engagement with Chesterbrook, Pa.-based DMW Direct. “A combination of media channels — digital, direct response TV and direct mail — are proving to keep our clients top of mind. As in years past, to make the most of limited budgets, DRTV schedules are flighted around direct mail drops to boost awareness and response. We can’t outspend national players, but we can outsmart them.”

The OEP, which runs from Jan. 1 to March 31 each year, allows beneficiaries who selected an MA plan during the AEP to make a one-time switch to another plan or change their coverage to Original Medicare.

“In addition to the emails and direct mail touches welcoming members and outlining specific benefits, member webinars have been an important part of our clients’ outreach,” adds Mezzanotte.

Getting in front of members with a strong onboarding strategy is critical, and that should start at the point of sale, says consultant Diane Hollie. It could be something simple that clearly describes the next steps. This should help avoid potential confusion or the feeling of buyer’s remorse, she suggests.

Another strategy Hollie is seeing clients explore is “understanding from the AEP where members have gone and how they can advertise against that.” This is the second OEP that CMS has allowed plans to make direct comparisons to other plans in their marketing, as long as the information is accurate and can be supported. Plans are also proactively using these direct plan comparisons in their age-in campaigns, she says.

“Member communication regarding COVID-19 has been an integral part of our clients’ plans over the last year and it continues in 2021 through email, mail, social media, and text,” Mezzanotte says. “While information is changing almost daily, it is crucial for plans not to shy away from speaking to their members even if it is to just to provide basic guidance.”