Report: Medicare Advantage Helped Sustain Providers, Enabled Faster Telehealth Adoption During COVID-19

Research shows how capitation and faster claim payment in MA buoyed cash-strapped physician practices, while risk stratification methods allowed health plans to quickly reach seniors most in need

Washington, D.C
. – Better Medicare Alliance, the nation’s leading research and advocacy organization supporting Medicare Advantage, announced the release of new research conducted by Health Management Associates (HMA) evaluating the Medicare Advantage community’s response to COVID-19 and key differences in Medicare Advantage and fee-for-service (FFS) Medicare’s abilities to meet beneficiary and provider needs.

The report is based on an extensive review of more than 70 publications and public data spanning the length of the ongoing pandemic and was supplemented by 18 in-depth interviews with Medicare Advantage plans and health care provider organizations.

Findings show that capitated payment arrangements in Medicare Advantage offered key flexibilities and financial support to providers facing revenue losses as patient visit volumes declined in the first months of the public health emergency.

As the report explains: “Providers who received capitation from health plans consistently described how these payments afforded them the flexibility to provide support to patients, enabled them to conduct more regular outreach to patients, and reduced their fears about revenue losses stemming from declines in visit volume.”

HMA’s research goes on to explain how Medicare Advantage’s faster transition to telehealth and its leveraging of supplemental benefit offerings helped keep beneficiaries safe in the home and supported providers’ efforts to deliver effective care during the pandemic.

Interviews conducted for the report revealed that “providers appreciated the quick action many health plans took to clarify coverage of virtual care services and key supplemental benefits helping beneficiaries remain safe and healthy in their homes.”

The report additionally finds that “while all of the providers interviewed stated Medicare’s expanded coverage of virtual care services was essential during 2020, several also stated Medicare Advantage was quicker than FFS Medicare to expand coverage of these services” early in the pandemic.

HMA’s research comes on the heels of separate Better Medicare Alliance-commissioned research showing that Medicare Advantage had lower COVID-19 hospitalization and mortality rates than FFS Medicare during the first nine months of COVID-19.

“Through extensive research and thoughtful interviews with leading health plans and providers, HMA offers unique insight into the actions that Medicare Advantage took during this unprecedented health crisis to keep beneficiaries safe from harm – all while playing an important role in keeping doctors offices’ doors open,” said Mary Beth Donahue, President and CEO of the Better Medicare Alliance. “From firsthand stories of health plans purchasing toilet paper for beneficiaries and offering virtual companionship to ease the pain of isolation that COVID-19 wrought for so many, to providers’ testimonials of Medicare Advantage’s faster transition to virtual care and quicker claims payment, this report shows how Medicare Advantage met the moment and showed up for beneficiaries and providers alike.”

“Our research concluded that throughout 2020, and in the face of the COVID-19 pandemic, Medicare Advantage (MA) health plans implemented several initiatives to support providers and Medicare beneficiaries. These initiatives were made possible by the flexibility of the MA model and exceeded the capacity of FFS Medicare to support providers and beneficiaries,” said Zach Gaumer, Principal at Health Management Associates and lead researcher on the report. “Providers we interviewed highlighted the flexibility of health plans to pay predictable capitated payment rates, offer supplemental benefits, and conduct care management activities as ways Medicare Advantage enabled them to stay afloat in the face of declining patient volumes and staff fatigue.”

“Over the course of COVID-19, ChenMed leveraged seven unique, specific types of outreach to keep our patients safe – from home medication and grocery delivery to placing more than 1.5 million ‘love calls’ proactively checking in on seniors most at risk. Through our efforts, ChenMed patients fared better in screening rates for breast cancer, diabetes, and cardiovascular care than FFS Medicare beneficiaries did even before the challenges of the pandemic,” said Stephen Greene, Chief Administrative Officer at ChenMed. “ChenMed was pleased to share our insights for this whitepaper and explain how we relied on the innovations and flexibilities uniquely found in Medicare Advantage to continue delivering personalized, VIP care that kept seniors healthy, happy, and at home throughout the pandemic.”

“From our vantage point delivering patient care in New England – one of the earliest COVID-19 hotspots – SoNE HEALTH witnessed how capitated arrangements like those in Medicare Advantage could help sustain providers when office visits abruptly drop,” said Lisa Trumble, President and CEO of Southern New England Healthcare Organization (SoNE HEALTH). “As we shared in interviews for this research, we saw providers who worried about the financial stability of their practice and whether they could keep their office doors open. Flexibilities in Medicare Advantage can offer an important solution. Working with Medicare Advantage plans also equipped us to deploy risk stratification to identify patients most in need. It was evident to us that Medicare Advantage members fared better during the pandemic in terms of outreach and touchpoints with plan sponsors and providers than those enrolled in FFS Medicare.” 

Read the full report HERE.

Watch an October 20, 2021 panel conversation at Better Medicare Alliance’s 2021 Medicare Advantage Summit previewing this report’s findings and featuring HMA’s Zach Gaumer and Elaine Henry, HERE.


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