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Meyers DJ, Gadbois EA, Brazier J, Tucher E, Thomas KS. Medicare Plans’ Adoption of Special Supplemental Benefits for the Chronically Ill for Enrollees With Social Needs. JAMA Netw Open. 2020;3(5):e204690. doi:10.1001/jamanetworkopen.2020.4690
In the Medicare Advantage (MA) program, which enrolls 34% of Medicare beneficiaries,1 private plans are paid per capita to cover enrollees’ needs. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2018, gave plans new flexibility to offer Special Supplemental Benefits for the Chronically Ill (SSBCI), which address enrollees’ social needs.2 Plans have discretion to target these benefits to enrollees with specific chronic conditions.
There is evidence that addressing enrollees’ social needs may be associated with positive outcomes and cost savings.3 However, plans have been slow to adopt new benefits.4 We analyzed the extent to which plans have offered new SSBCI in 2020.
This cross-sectional study used publicly available benefit, plan characteristic, and enrollment files to characterize which plans offered new benefits. Examples of SSBCI newly allowed in 2020 include meal and produce delivery services, nonmedical transportation, pest control, air conditioning, and other benefits to address social needs.5 This study did not require institutional review board review because it used publicly available nonhuman participant data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
We compared the characteristics of plans (ie, type, size, star rating, age, nonprofit status) that offered SSBCI in 2020 using 2-sided χ2 tests with α = .05. Analyses were performed using Stata, version 15 (StataCorp) in December 2019.
In 2020, 139 of 3052 plans (4.6%) offered an SSBCI. Pest control (66 plans [2.2%]) was most frequently offered, followed by produce (63 [2.1%]) and meal delivery (55 [1.8%]) (Table 1).
Health maintenance organizations (130 plans [6.2%]), plans rated 4 to 4.5 stars (90 [5.4%]), dual (26 [7.5%]) and chronic (27 [24.3%]) special needs plans, and plans created from 2006 through 2013 (57 [5.7%]) were most likely to offer a new SSBCI (all P < .001) (Table 2).
Results suggest that MA plans’ adoption of new SSBCI has been limited in 2020, with an estimated 4.6% of plans offering any new benefit. The areas of largest growth are in pest control, produce, and meal programs, which previous work has documented are areas of interest for plans.6 Many plans may also have experience offering these benefits through managed Medicaid.
Health maintenance organizations, older plans, and plans with higher ratings more frequently offered new benefits. Older plans may have an established infrastructure that allows for the early adoption of new services. Plans rated 4 stars or higher receive bonuses from the Centers for Medicare & Medicaid Services (CMS) in the form of rebates, which may be used to invest in new services for enrollees.
Regulations detailing what benefits may be covered are generally released in April, and final benefit proposals must be reported to CMS in June. This short period may limit the ability for plans to make decisions in time for the next benefit year.6 Limited evidence for the return on investment of these benefits, uncertainties about the extent and parameters of new benefits allowable under the regulation, and the lack of additional funding from CMS for these benefits may also be associated with low adoption.6
This study has limitations. Plans use text entry fields to capture new benefits in the benefit files. This analysis may be limited if any of these benefits were misclassified. Given reinterpretation of the uniformity requirement,5 we cannot determine how many enrollees had access to a benefit.
The CHRONIC Care Act received substantial attention for encouraging plans to offer benefits to address enrollees’ social needs. However, in the first year, relatively few plans took advantage of this flexibility. It remains to be seen the extent to which these new benefits will become widely available to MA enrollees.
Accepted for Publication: February 28, 2020.
Published: May 12, 2020. doi:10.1001/jamanetworkopen.2020.4690
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Meyers DJ et al. JAMA Network Open.
Corresponding Author: Kali S. Thomas, PhD, MA, Center for Gerontology and Healthcare Research, Brown University School of Public Health, 121 S Main St, Providence, RI 02912 (Kali_Thomas@brown.edu).
Author Contributions: Dr Meyers had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Meyers, Thomas.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Meyers, Tucher, Thomas.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Meyers.
Administrative, technical, or material support: Gadbois, Brazier, Tucher.
Supervision: Gadbois, Thomas.
Conflict of Interest Disclosures: None reported.
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