Experts: Payers, providers can innovate but need marketing guardrails under CHRONIC Care Act

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Marketing of supplemental benefits under the CHRONIC Care Act may be a sticking point for payers and providers. (tupungato/iStock/Getty Images Plus)

The CHRONIC Care Act offers plenty of room for providers and payers to innovate complex care management, but it’s crucial to do so in a way that’s easy for patients to follow, experts say. 

Under the legislation, passed in February as part of the Bipartisan Budget Act, Medicare Advantage plans can offer supplemental benefits that can benefit chronically ill patients, such as transportation, counseling and nutrition services. It also expands MA plans’ ability to offer telehealth. 

However, Medicare patients, a third of whom are enrolled in MA plans, may not understand that they can access these benefits or how to take advantage of them. So, policymakers need to consider building outreach guidelines to drive effective marketing, said Lina Walker, vice president of health security at AARP’s Public Policy Institute.  

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2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

“There needs to be a guidance around what’s marketed and how it’s marketed to patients and consumers,” she said. 

But while regulators can provide some direction for the rollout of the CHRONIC Care Act, Walker said that for its benefits to really stick, they also need to maintain flexibility for different payers and providers to address individual community needs. 

Walker was one of several speakers at an event on the topic hosted Thursday by the Bipartisan Policy Center. 

RELATED: Telehealth expansion takes a step forward with Senate’s passage of CHRONIC Care Act 

It’s important to address that patients are unaware of nontraditional benefits that could benefit them, but there are risks in overstating the use of these policies, the panelists said. 

Sean Cavanaugh, chief administrative officer at Aledade, said that making benefits clear to patients isn’t the same as actively seeking out potential members to enroll in supplemental options. 

“We know these benefits will not have a return on investment if they’re not targeted,” he said. “It's not about recruiting patients.” 

RELATED: New Medicare marketing guidelines raise the specter of past predatory sales tactics

“Marketing” may not be the right way to look at this issue, he said, as payers wouldn’t want to necessarily promote such benefits to all of their membership and instead offer them to patients with a real need. Additionally, a recent change to Medicare marketing guidelines opens up new avenues for insurers to market plans, but also could also create opportunities for predatory sales practices. 

Some insurers are concerned the new benefits may be prone to misinterpretation, and some have gone to greater lengths to help patients understand which new benefits are available to them.

Allison Schwartz, a former representative from Pennsylvania and CEO of the Better Medicare Alliance, said that patients will, to some degree, understand the supplemental benefits for chronic disease aren’t for everyone just by the fact that they’re offered under Medicare, but payers will need to balance their approach to outreach. 

“I do think plans both kind of want to market this, but they’re also very concerned that they don’t oversell it either—because they don’t want to have unhappy beneficiaries,” Schwartz said.

A video of the full event is embedded below:

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