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.