BMA Urges Stronger Health Equity Metrics, Medicare Plan Finder Improvements, In-Home HRA Best Practices in Letter to CMS
Coalition of more than 170 diverse stakeholder organizations and over 600,000 grassroots advocates offers slate of 12 forward-looking policy solutions to better serve seniors ahead of annual CMS Rate Notice process
Washington, D.C. – Better Medicare Alliance, the nation’s leading research and advocacy organization supporting Medicare Advantage, sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure outlining proposed solutions to better serve Medicare Advantage beneficiaries and deliver continued value for the health care system.
The letter, sent on behalf of BMA’s more than 170 diverse Ally organizations and over 600,000 grassroots advocates, comes as CMS prepares its Calendar Year (CY) 2023 Medicare Advantage rate and policy-setting process.
In its correspondence, BMA highlights the current successes of Medicare Advantage – keeping average monthly premiums at a 15-year low, bringing Star Ratings for 2022 to a record high, delivering fewer hospitalizations and emergency room visits, and enrolling a proportionally more diverse, lower-income population than fee-for-service (FFS) Medicare – while offering specific proposals to address social determinants of health, close the gap on longstanding racial disparities in health care, and ensure high-quality in-home health risk assessments (HRAs).
Among the dozen policy solutions proposed by BMA:
- Combating racial and ethnic disparities in health care and advancing health equity by strengthening quality measures to account for social risk factors: BMA supports the adoption of appropriate quality measures related to the social determinants of health and modifying the existing Medicare Advantage Star Rating quality measures to account for social risk factors. For example, additional measures could include the beneficiary’s experience with how their social needs were addressed or the adoption of the Health Equity Summary Score to measure a health plan’s ability to address social risk factors.
- Enhancing Medicare Plan Finder to bring greater transparency to plans’ supplemental benefit offerings: BMA proposes standardizing the format and language used to discuss supplemental benefit offerings in Medicare Plan Finder, while also requiring the disclosure of additional information about supplemental benefits on the site.
- Strengthening and expanding the Value-Based Insurance Design (VBID) model: As the only Medicare Advantage (MA)-focused demonstration model currently authorized by the Centers for Medicare and Medicaid Innovation (CMMI), BMA recommends policy actions to build on the program’s track record of success. These policy options include allowing additional Medicare Advantage plans to participate—including Employer Group Waiver Plans (EGWPs) – and considering permanent authorization at the end of the demonstration project.
- Codifying best practices for health risk assessments conducted during an in-home clinical visit: In 2015, the Obama administration’s CMS encouraged “plans to adopt, as a best practice, a core set of components for the in-home assessments they perform.” BMA supports codification of a robust set of best practices that stipulate who can perform in-home clinical assessments, what components must be included, and what processes exist for determining needed follow-up care.
“In this letter, Better Medicare Alliance is committing to partner with our leaders in the Administration who we know share our goals of accelerating the drive to health equity, rooting out health disparities wherever they exist, addressing social determinants of health, and raising the bar on in-home care,” said Mary Beth Donahue, President and CEO of the Better Medicare Alliance. “Medicare Advantage serves over 27 million Americans – a proportionally more diverse, lower-income, and more at-risk population than FFS Medicare – and they are counting on its continued ability to meet their health and social needs. With these solutions, we can continue and build on the trajectory that is delivering better outcomes for seniors while providing measurable savings and efficiencies for the federal government.”
“With 53% of Medicare-eligible Latinx individuals choosing Medicare Advantage today, we at National Hispanic Medical Association have a keen interest in preserving and strengthening Medicare Advantage for the future. We welcome this set of solutions that will ensure Medicare Advantage is equipped to continue providing the quality, affordable care our community needs and deserves,” said Elena Rios, MD, MSPH, President and CEO of the National Hispanic Medical Association.
“Medicare Advantage and further integration into our healthcare delivery system is important to the future of the Meals on Wheels network and its ability to serve the millions of seniors who are struggling with hunger and isolation every day,” said Lucy Theilheimer, Chief Strategy and Impact Officer of Meals on Wheels America. “By safeguarding supplemental benefit offerings like meals and nutritional assistance and aligning incentives for Medicare Advantage health plans to build on these social supports, CMS would help more older Americans maintain independence and reduce fear of hunger.”
“As a leading provider of comprehensive, in-home medical care for some of our most vulnerable seniors, we at Landmark Health know that Medicare Advantage provides opportunities to identify and address beneficiaries’ social needs. With help from Washington, providers and health plans are ready to do even more,” said Nick Loporcaro, CEO of Landmark Health. “We applaud these policy solutions that will further improve Medicare Advantage’s ability to connect the right beneficiaries with the right services at the right time.”
“Medicare Advantage has proven its value to our nation’s seniors time and again, and SilverSneakers is proud to play a role in that success. Research shows that beneficiaries participating in SilverSneakers programs have fewer inpatient hospitalizations and emergency department visits and lower overall health care costs, just to name a few,” said Richard Ashworth, President and CEO of Tivity Health. “We join Better Medicare Alliance in supporting these solutions to address social determinants of health and build on the future of supplemental benefits in Medicare Advantage because we see firsthand the difference these opportunities make in seniors’ lives.”
“As one of the largest providers of in-home health evaluations in the country, we support these recommendations to codify best practices and related measures regarding in-home evaluations to ensure that every beneficiary derives meaningful value from in-home clinical visits,” said Marc Rothman, MD, Chief Medical Officer at Signify Health. “At Signify Health, we know that meeting beneficiaries where they are – in the home – offers an important opportunity to gain a holistic picture across multiple critical dimensions: clinical, functional, behavioral, and social. By codifying best practices for in-home health evaluations and establishing guidelines for follow-up care, CMS can help demystify this deeply important and highly valuable component of preventive health and care delivery.”
“Roughly half of Black Medicare beneficiaries today choose Medicare Advantage, uniquely positioning Medicare Advantage to play a decisive role in our efforts to stamp out longstanding racial disparities in health care and accelerate the drive to health equity,” said Daniel E. Dawes, JD, Executive Director of the Satcher Health Leadership Institute at the Morehouse School of Medicine and Member of the Better Medicare Alliance Council of Scholars. “I am encouraged by the Medicare Advantage community’s eagerness to take up that mantle of leadership and work with CMS on shared goals. The well-reasoned solutions outlined in this letter can mark an important step forward in that process.”
Read BMA’s full letter to CMS HERE.