SAN DIEGO—Insurers need to lead the way on supplemental benefits, including paying for transportation and healthy food, to help curb unnecessary serious illnesses and premature hospice care.
"We need you to make it financially feasible to take care of people at home. Because if you don't, we'll send them to the emergency department because we have no alternative."
That is the ultimatum Diane Meier, M.D., founder and director of the Center to Advance Palliative Care, gave to health insurers during one session at the 2018 AHIP Institute & Expo in San Diego.
Costly emergency room visits are often unnecessary, and both private insurers and the government have tried ways to curb their overuse. About 71% of emergency room visits are avoidable and cost on average over $1,000 per visit, according a study by Truven Health Analytics.
Meier said that under current payment systems, it is much easier for patients to be medically treated for preventable diseases than actually preventing them in the first place, and that must change.
Her remarks follow the Centers for Medicare & Medicaid Services' decision earlier this year to broaden and expand Medicare Advantage supplemental benefits in the next few years. Plans will soon be able to cover nonmedical services including groceries, transportation and air conditioning to better personalize care.
Meier urged health insurers to cover services that would identify and adjust environmental factors that could lead to unnecessarily ED visits, such as proper nutrition, safe living conditions and visits to prevent loneliness.
She specifically mentioned how under palliative care, an elderly man she treated with was able to get transportation to church services to help prevent social isolationism.
"This is what we need you to help us be able to deliver," she said.
Terry Gilliland, senior vice president and chief health officer at Blue Shield of California, appeared to agree with Meier's recommendations and said that covering such services would reduce costs and improve quality of life.
"We are very enthusiastic about how this [CMS] policy has given us the opportunity to create a new health system that is sustainably affordable, because right now it's not," he said.
Andrew MacPherson, senior policy adviser at the Coalition to Transform Advanced Care, called the CMS' supplemental benefits expansion a "game changer" but that covering food and transportation is only the beginning and that future options could include housing and bereavement services as well.
"We've come a long way, but we still have a long way to go," he said.