Shifting Landscape

The landscape of Medicare Advantage (MA) supplemental benefits has undergone a significant transformation over the past five to six years, evolving to meet the diverse needs of over 30 million Americans enrolled in these plans. A recent report by Leavitt Partners, in collaboration with The Helper Bees, and communicated through Home Health Care News, provides invaluable insights into this evolution, highlighting the potential for MA plans to revolutionize the provision of at-home care by drawing inspiration from state Medicaid programs.

The Expansion of Supplemental Benefits

Medicare Advantage plans have long been valued for their additional benefits, which extend beyond traditional healthcare coverage to include dental care, fitness and wellness programs, transportation services, and in-home support. These benefits have grown from a narrow set of offerings to a comprehensive suite of services designed to improve the quality of life for seniors, enabling them to receive personalized care that addresses their specific health and lifestyle needs.

However, as supplemental benefits have expanded, so has the necessity to substantiate their value. The report suggests that mirroring the regulatory model used by Medicaid for home and community-based services could be the key to proving the worth of these benefits. This model has proven effective in delivering essential services, ensuring quality care through regulated oversight, training, and background checks.

The Challenge of Standardization

One of the major challenges identified by the report is the lack of standardized data to evaluate the impact of MA supplemental benefits. Without comparable data, it’s difficult to understand what benefits plans are offering, what services beneficiaries are utilizing, and the quality of those services. This gap in data hampers the ability to measure the success of plans in managing non-clinical service providers and the overall return on investment for the federal government.

More importantly it sets-up a future state where these benefits are potentially eliminated due to the lack of evidence of success. To address this critical issue, it is imperative for stakeholders within the Medicare Advantage ecosystem to prioritize the establishment of a standardized data collection and reporting framework. Such a framework would enable a comprehensive understanding of the range and effectiveness of supplemental benefits, facilitating informed decision-making and policy development. By demonstrating the tangible value and positive outcomes of these benefits through robust evidence, we can ensure their sustainability and prevent their premature elimination. Ultimately, this will not only safeguard the interests of beneficiaries but also enhance the overall efficacy and efficiency of the Medicare Advantage program, ensuring that it continues to meet the evolving needs of its enrollees.

The Medicaid Model: A Blueprint for Success

Andrew Friedell, COO of The Helper Bees, argues that the Medicaid model offers a reliable framework for delivering in-home support services. This model not only ensures the quality and safety of care through stringent regulations but also provides access to a broader range of services, including homemaker and personal care services. By adopting this approach, MA plans can overcome the skepticism associated with newer models of care delivery, such as the 1099 contractor model, which faced backlash for its lack of regulatory oversight.

For home care agencies, the evolving landscape of MA supplemental benefits presents a unique opportunity to align more closely with MA plans. By leveraging improved data and insights, agencies can better position themselves within this growing market, offering a wider array of services to meet the needs of MA beneficiaries.

Looking Ahead

The report by Leavitt Partners and The Helper Bees invites stakeholders to reconsider how supplemental benefits are integrated within MA plans. It underscores the need for innovation, collaboration, and a commitment to leveraging data to enhance care delivery. As we look to the future, the potential for MA plans to transform the healthcare experience for seniors is immense.

At Enable Dental, we are dedicated to leading the charge in this transformation, ensuring that seniors have access to comprehensive, high-quality dental care in the comfort of their homes. We believe in the power of at-home care benefits to change the face of healthcare, making it more accessible, personalized, and effective for everyone involved.

The journey toward revolutionizing home care is just beginning, and together, we can make a profound impact on the lives of millions of Americans.