Why supplemental benefits in MA mark a 'turning point' for Medicare policy 

It’s crucial that the rollout of early supplemental benefits in Medicare Advantage (MA) is done carefully to set a strong foundation to build from.  

A new report from Anne Tumlinson Innovations, the SCAN Foundation and the Long-Term Quality Alliance aims to help MA plan sponsors implement these new benefits through a set of guiding principles. The report calls the new benefits a “turning point in Medicare policy.” 

Bruce Chernof, M.D., president and CEO of the SCAN Foundation, told FierceHealthcare that Medicare was implemented initially for a very different demography of seniors than those enrolled in the program today, so its evolution toward addressing more modern needs like the social determinants of health must be carefully considered. 

“We need this to be successful—it’s good for people, first and foremost,” Chernof said. “And it lays a predicate for a larger discussion.” 

RELATED: 21% of MA enrollees offered supplemental benefits in 2019 

The Centers for Medicare & Medicaid Services (CMS) finalized in April its plan to allow MA plans to cover certain supplemental benefits for targeted social determinants like air quality and food. The CHRONIC Care Act, which was passed in 2017, also expanded those options

Chernof said that using these early supplemental benefit options effectively paves the way for further discussions on which should potentially be elevated to a permanent benefit and which areas should be explored for supplemental benefits in the future. 

“Doing this well actually helps create a much broader and richer discussion, with data underneath it,” he said. 

The report is built on four principles: 

  1. Supplemental benefits must be clear and easy to understand. 

  1. They should be equitable. 

  1. They should be designed in a manageable and sustainable way. 

  1. Such benefits should evolve as more data and experience are gained. 

RELATED: CVS launching platform to allow PBM clients to manage supplemental benefit contracts 

Chernof said a diverse group of industry stakeholders participated in the discussions that birthed these guidelines and that having those mixed voices was crucial, because payers, providers and advocates are all at different points in the social determinants of health journey and come from different perspectives. 

Aligning these views also creates a broad coalition that can work together with CMS to discuss future evolutions of these benefits, he said. 

And, once these groups have a strong knowledge base in using such benefits in MA, the industry can begin to adapt them more effectively in traditional Medicare or in private plans, Chernof said. 

“The bottom line is people should care a lot about how this gets launched,” he said