Serving Nontraditional Health Care Needs in Medicare Through VBID

Panelists touted the ability to pay for items and repairs to keep Medicare beneficiaries healthier at home, avoiding potentially costly hospitalizations and complications.

The expansion of value-based insurance design (VBID) into Medicare has fueled new creativity in thinking about how to support beneficiaries beyond what is considered a traditional health care service, according to a panel discussion at the 2022 V-BID Summit, hosted by the Center for Value-Based Insurance Design at the University of Michigan.

Moderated by Clifford Goodman, PhD, senior vice president, comparative effectiveness research, The Lewin Group, the speakers at the “Expanding Role of Supplemental Benefits by Public and Private Payers” session touted the flexibility to provide things such as home repair (eg, fixing something that could be a fall hazard) or an air conditioner to someone who has asthma.

The virtual session, with Mary Beth Donahue, president and CEO of the Better Medicare Alliance; Joy Cameron, associate vice president of public policy at Humana; and Laura McWright, deputy director of the Seamless Care Models at the CMS Innovation Center, kicked off with a discussion about the role of supplemental benefits.

In 2018, CMS began moving toward aligning services targeting social determinants of health in Medicare Advantage (MA) and adding additional supplemental benefits to patients who are chronically ill, such as meals and transportation.

“From your standpoint, at Humana, when and how did you start thinking about supplemental benefits?” Goodman asked Cameron, who referenced the company’s “Bold Goal” initiative, an ongoing Humana population health effort that pulls in the CDC’s Healthy Days measure.

Supplemental benefits provide for the ability to get ahead of potential problems before they become an acute crisis, Cameron said.

“Was that a hard case to make internally at Humana and is it viewed within the company as a competitive benefit offering? In other words, you look better if you offer these things?” asked Goodman.

Cameron demurred from the idea that it makes Humana look “better” because of these offerings; Rather, she said, “I think it’s, our members are inclined to stick with us because we’re better able to serve them.”

Touchpoints with members take various forms, she said, ranging from case managers noting that a member hasn’t been to the doctor yet that year, or a home wellness assessment.

Donahue, of the Better Medicare Alliance, noted that the MA population is comprised of mostly low-to-moderate income individuals; more than half are living below 200% of the poverty line, and since 2013, so-called “duals”—those patients who qualify for both Medicaid and are enrolled in MA—has grown by over 125%. Half of MA members are people of color.

Some communities have the additional barriers of social isolation, poor nutrition, and poor transportation, Donohue noted.

“VBID offers a practical laboratory to test, target, and refine and spread supplemental benefits,” Goodman said, summing up the conversation, asking the speakers to give an idea of ​​where these supplemental benefits are headed next.

“I think the the health equity incubation program is a biggie, because I think it really is going to bring together all this sort of past operational sort of lessons and initial lessons from VBID and allow plans to kind of hit the ground running that are either here now with us or want to come in and test in the underserved populations, because they have the ability to do it,” said McWright.

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