November 2, 2022

Better Medicare Alliance 2022 Medicare Advantage Summit

Table of Contents

Executive Summary

Tuesday, October 18 – Wednesday, October 19, 2022

Event page here

 

On Tuesday, October 18 and Wednesday, October 19, 2022, the Better Medicare Alliance (BMA) gathered industry and federal experts to discuss the advancement and future of both the Medicare Advantage (MA) program and value-based care as a whole. Over the course of two days panelists and speakers reflected on the current state of the MA program, challenges forthcoming to the program, and how the political landscape may impact changes in policy and oversight.

 

Innovation spotlight sessions and breakout room discussions also shared lessons on specific topics, such as addressing mental and behavioral health in senior populations, the future of telehealth, and lessons learned from the COVID-19 pandemic.

Day 1: October 18, 2022

In their Own Words:  Why Support MA?

October 18, 2022 | 9:40-9:50 AM

Speakers

Takeaways

  • MA provides a layer of support for the elderly and disabled on top of Medicaid. Hard-working Americans should be able to retire and live securely, MA provides affordable and accessible healthcare coverage.
    • Those who would not have previously been able to afford private healthcare can attain affordable and dependable healthcare through MA.
    • Marginalized groups are getting basic primary care at higher rates than ever before.
  • MA covers many benefits that were not previously covered by Medicare. Strengthening MA will benefit the whole public healthcare system and current MA beneficiaries.
  • MA nearly eliminates the dread of excessive billing for beneficiaries, pushing more and more people to get basic primary care.
  • Healthcare can be fixed through innovation, transparency, and consumerism.

 

Keynote: Improving Health Outcomes in Medicare

October 18, 2022  | 10:00-10:40 AM

 Speakers

  • Mary Beth Donahue, President and CEO, Better Medicare Alliance
  • Kathryn Coleman, Director, Medicare Drug and Health Plan Contract Administration Group, Centers for Medicare and Medicaid Services

Takeaways

  • The BMA meets with lawmakers, representing over 6,000 Medicare beneficiaries. In doing so, The BMA empowers individuals to advocate for themselves and their needs.
  • MA encompasses nearly half of Medicare beneficiaries and will soon cover over half of them.
    • Medicare Advantage has the lowest premiums in 16 years.
    • Consumer satisfaction with Medicare Advantage is at 94%.
    • 99% of plans include ideal benefits for the consumer.
  • The bipartisan government heavily supports MA. More than 400 members of Congress wrote letters of support for the program. With growing support for MA throughout both Democrats and Republicans, increases in budget for MA could be coming.
  • While Medicare Advantage has done great work in minimizing inequalities across the healthcare system, there is still a long way to go.
    • Transportation assistance, nutritional assistance, and accessibility are among a number of concerns that Medicare Advantage has yet to heavily address.
    • The first step is making sure people receive information that they can read. Patient independence is critical to improving the public healthcare system.

 

Spotlight on Innovation:

How MA Improves Chronic Disease Management

October 18, 2022  | 10:50-11:20 AM

 Speakers

  • Smit Patel, Innovation Lead, Digital Medicine Society (DiME)
  • Geoff Matous, President and Chief Commercial Officer, Wellinks

Takeaways

  • Chronic Obstructive Pulmonary Disease (COPD) is a prime example of chronic disease management under Medicare and Medicare Advantage.
    • 25 million patients have chronic obstructive pulmonary disease.
    • COPD requires complex care, and patients are often located in rural areas.
  • For many COPD patients, there is no path to care without MA. Innovations for COPD are lacking, largely due to the number of patients located in rural locations without developed research centers.
  • Many seniors are afflicted with COPD and find treatment through Medicare Advantage.
  • Breaking down access barriers is critical both for patients and innovations.
    • There is a shockingly low percentage of treatment for CODP for those on Medicare.
    • Location plays a huge role in access.
      • This is where telehealth can play a huge role in treatment.
      • Virtual and center-based treatment have been proven to be on the same level.
    • While COPD is just an example, addressing access barriers is critical in improving the healthcare system.
    • Addressing the whole health of the individual in very important. This goes beyond physical needs. Mental health plays a huge role as well and needs to be addressed in health plans going forward.
    • Virtual care and telehealth need to be utilized more. Not only is it more efficient, but virtual care allows less exposure to illness, more comfortable conversations, and an overall easier experience for the patient and the provider.
    • Care needs to be consistent across providers. The disparity from one provider to another can often be significant. Creating more consistent care across practices allows for better quality care overall.
    • Healthcare paths are messy and need to be simplified. It is easy for patients to get lost from one point to another when dealing with providers and payers.
    • While it is easy to look at the progress made in public health care, it is even easier to ignore those who aren’t benefiting from it.
      • Awareness is key in addressing the social disparities in public healthcare.
    • It is often misinformed that seniors don’t use tech or don’t know how.
      • Building and designing solutions that simplify the healthcare process is necessary to make it more efficient for seniors to utilize healthcare services.
      • In addition, engaging and connecting with seniors helps retain them, which leads to a better provider-patient connection.
    • Virtual care access across state lines needs to continue. The end of the public health emergency (PHE) is threatening this.

 

Health Status Landscape

October 18, 2022  | 11:20 AM-12:00 PM

 Speakers

Takeaways

  • There has been a dramatic growth in Medicare Advantage beneficiaries.
    • Nearly half of Medicare choose Medicare Advantage
  • Social disparities exist among Medicare and Medicare Advantage users
    • MA beneficiaries are more likely to be low-income.
    • MA beneficiaries are also more likely to be dual-eligible for Medicaid.
    • MA users are more likely to be Black, Latinx, or Asian.
      • Language and health literacy needs are increased in MA as a result.
    • Housing and food insecurity are more prevalent among MA users. Individuals who rent are more likely to have food insecurity and lack basic necessities.
    • Clinical, functional, and cognitive disorders are more prevalent among Medicare and MA users compared to the rest of the population.
      • MA users experience chronic conditions at modestly higher rates than Medicare users.
        • MA users are more likely to have a stroke, chronic lung disease, diabetes, high cholesterol, and high blood pressure.
      • Medicare and MA beneficiaries report mental health conditions at similar rates.
    • The current healthcare system is built on treatment rather than prevention. Reorganizing the system to address prevention rather than treatment would address many of the disparities described above.

Panel: Future of Medicare

October 18, 2022  | 1:00-1:50 PM

Speakers

Takeaways

  • There has been remarkable growth in the Medicare Advantage program.
    • More and more seniors are joining MA.
    • The FFS cost-sharing system is broken and the benefit structure unorganized.
    • MA has better care coordination through patient data and feedback.
    • In many instances, Medicare Advantage addresses the gaps in Medicare.
    • The private-sector model is more stable and trustworthy among patients.
  • With growth comes new challenges.
    • MA will soon be the majority public healthcare program.
    • The payment structure, cost structure, and benefit structure will all have to change.
    • Management will have to adapt and evolve with the growing demand for MA.
  • Patients receive a different level of sophistication using Medicare Advantage over Medicare, the care tends to be more complex and complete.
  • Drug benefits are now an expectation from payers.
  • With a bipartisan government, there is little threat to major cuts for MA. Also , a divided government cannot make huge changes.
  • There is a lot of talk about the debt limit. While this could lead to minor cuts for public healthcare spending, both Democrats and Republicans are in support of MA, so no major changes should occur.
  • Medicare Advantage is significantly larger than in 2010. As the program gets larger, small budget cuts become more of a threat. However, as the program expands, so do its expenses.
  • While MA is doing much better than in 2010 and at a point of broad bipartisan support, budgetary realities are coming into play.
    • However, political bandwidth is a very real thing, and if the administration doesn’t see it as a priority to change MA, it most likely won’t.

Breakout 1A: Lessons Learned During the Pandemic

October 18, 2022  | 2:00-3:00 PM

Speakers

  • Jennifer Podulka, Vice President of Federal Policy, America’s Physician Groups
  • Justin Barclay, Vice President of Consumer Insights and Analytics, Tivity Health
  • Lisa Tripp, Vice President of Government Affairs, Medically Home
  • Keith Reynolds, Chief Operating Officer, Welldoc

Takeaways

  • Medicare expansion is difficult for at-home programs Access to at-home fitness programs is often not covered by Medicare.
    • This is the case for Tivity Health.
    • Nutritional programs face the same challenges.
  • Making people aware that there is a solution out there is critical for both providers and patients. Welldoc faced this challenge and adapted by advancing its communication methods through social media.
  • The option for at-home care needs to be normalized and communicated.
    • Medicare FFS pays for just the acute episode, and nothing more. This means that patients are often sent home before they are fully recovered.
    • Medically Home helps combat this issue. Medically Home can extend care weeks beyond what a patient’s hospital stay would’ve looked like.
  • The pandemic forced digital health to evolve in a very short timeframe.
    • Staying connected is key for telehealth to work. Meaningful interactions help individuals manage their care.
    • Fitness is social connection, nutrition, and physical activity.
      • With the pandemic, at-home fitness became critical for individuals. Through this demand, companies like Peloton took advantage of the situation.
    • Digital health should theoretically address any disparity. However, there are still gaps in equity.
      • Welldoc analyzed the populations it served and found clear inequities among its population. Older phones, non-Apple devices, limited data, and limited reception are examples of disparities that still affect digital health.
    • Individual needs will be different every time. Customizing a patient’s care is critical to their treatment and experience.

 

Breakout 2A: Future of Telehealth

October 18, 2022  | 3:10-4:10 PM

 Speakers:

Takeaways

  • Some Medicare Advantage plans offered telehealth services as a supplement benefit prior to 2019. Now, 98% of MA plans offer telehealth services as a supplemental benefit.
    • COVID forced virtual communication to adapt, especially telehealth services.
  • Broader coverage and reimbursement for telehealth will promote competition and lower patient cost.
  • Providers need to consider things that aren’t traditional telehealth, especially in-home patient monitoring.
  • Nearly all of the barriers to telehealth have nothing to do with telehealth. Cost, the enrollment process, general access, and connectivity all can prevent patients from receiving the care they need.
  • Digital solutions enable those who think they need in-person care to make sure they need in-person care.
    • Telehealth helps filter out patients who only need virtual care.
    • Telehealth helps keep hospitals open for those who do need in-person care.
  • For those who identify as LGTBQ+, it can be challenging to find providers to fit their specific needs. Included Health vets providers nationwide to make sure they provide caring and complete service.
  • Many coverage plans don’t offer support for chronic illness care. Adopting solutions for support for chronic illness care is necessary.
  • Access to care is just one side of the story. Patients need to be versed in healthcare literacy to understand and take full advantage of their benefits.
  • Virtual health allows patients to have a more consistent and ongoing experience with their providers. Building these relationships builds trust and makes it more likely that these beneficiaries will continue getting the basic care they need.

Day 2: October 19, 2022

Keynote: Balancing Innovation Models

October 19, 2022 | 9:00-9:40 AM

 Speakers:

  • Liz Fowler, Deputy Administrator and Director, Center for Medicare and Medicaid Innovation
  • Moderator: Mary Beth Donahue, President and CEO, BMA

Takeaways

  • With over 29 million people enrolled in Medicare Advantage, it is critical that providers find meaningful and efficient solutions for patients.
  • Streamlining and increasing the efficiency of prior authorization will decrease the negative effect that prior authorization has on patient outcomes.
  • Moving towards patient-centered healthcare will improve healthcare across the board. This means truly individualizing and customizing plans / treatment on a patient-to-patient basis.
  • The trial-and-error model doesn’t really work. Payers and providers alike need to stick with what works, “have the vision”, and execute.
  • Patient relations with providers need to get better. This means connecting, engaging, and working together to provide proper treatment and trust.
  • Legislators need to examine what other countries are doing and attempt to move toward that model.
    • Europe is a great example of a system where patients get quality care and taxpayers aren’t extremely burdened.
  • Patient voices are critical for reshaping the healthcare system.
    • The country needs a better feedback system on which to base its improvements.
  • Equity and social detriments need to be considered for change in the system that will benefit everyone. At the moment, there is a ton of room to make change in the current system.

 

Panel: How Value-Based Insurance Design is Identifying and Addressing Health Care Needs

October 19, 2022 | 9:40-10:40 AM

Speakers

Takeaways

  • Americans do not directly care about health care costs, rather, they care about how much care costs them.
  • Transportation, nutrition, mental health all need to be included as benefits
  • With ChenMed’s work coordinating and providing primary care for seniors, it is important to inform and incorporate doctors when determining what stake, they have in the model.
  • To make value-based care better, there needs to be a better environment for providers. ConcertoCare focuses on providing care to patients in the home, which can be incredibly difficult. Because of this, it is important to make this process rewarding and seamless, and that providers feel like they are doing house calls with support.
    • ConcertoCare supports providers by leveraging technology to stratify and identify high-risk patients, triaging extra care to where it is most needed. They also utilize “assisted telehealth” services, which means a are coordinator goes into a patient’s home and helps them set up the telehealth device / conduct the appointment to create a seamless experience on the provider’s side as well.
    • To make at-home care valuable for patients, there are no OOP costs associated with these services.
  • It is important to realize the best-intentioned value-based care policies are not always implemented as planned. Rosales of VNS Health highlighted an example of this, when CMMI introduced a flexible hospice model.
    • Currently, hospice can only be paid for once a beneficiary decides to completely stop curative services, oftentimes delaying needed hospice care.
    • This model was designed to allow for some overlap in the two services to encourage a smoother transition to hospice care.
    • Despite the great idea for the model, there was little uptake because providers themselves were not familiar or comfortable with the concept, because they were used to operating in the status quo, which required a very delineated stop/start.
    • Now, VNS is working to educate both providers and beneficiaries of this model, which is not something the model designers anticipated. Details like this are key in implementation.
  • It is contradictory to claim these programs are cost neutral, as the only “true” way to overall reduce costs is death, which is not the goal of any healthcare organization. Because of this, value-based models often have levels of friction between all stakeholders without proper implementation. Panelists shared some ways of reducing this friction:
    • Changing the nature of incentives of “reducing costs” to “doing what’s right for the patient”. The financial benefits will usually follow if this is the core principle.
    • Improving access to hospice care, which may be an initial source of friction, but overall makes the beneficiary’s experience better, and overall reduces utilization.
    • Taking provider-focused approaches to strengthen partnerships.
    • There are many choices of MA plans on the market, plans need to take more of a proactive approach in educating people on the benefits they have available and what best suits their needs.
  • Panelists each shared an action item for the audience to focus on and grow value-based care:
    • Wellvana: Prioritize timeliness of payments to bolster provider relationships.
    • ChenMed: Create flexibility for providers taking risks.
    • ConcertoCare: Keep the social determinants of health in mind when designing care models, because while it may be an after-thought for some, it is the lived reality of most beneficiaries.
    • VNS Health: Providers should feel empowered to create a voice for themselves in value-based care and MA—participate in discussions like this event.

 

Spotlight on Innovation:

The Future of Value-Based Care

October 19, 2022 | 10:50-11:20 AM

Speakers:

  • Zahoor Elahi, Chief Operating Officer, Health at Scale
  • Moderator: Ben Leonard, Health Technology Reporter, Politico

Takeaways

  • Value-based care currently operates in two dimensions—low-value and high-value—but should really shift to operating in four: high-value, low-value, zero-value, negative-value. Furthermore, treatments should not be relegated to one distinctive value in this measure set, as different treatments will have different values for different patients.
  • Health care needs to be personalized so that patients can define value on an individual level. Elahi is currently most excited for innovations that will allow MA plans to get updates on their members’ health status on a real-time, month-to-month basis and really tailor their value-based care.
  • Data can enable that personalization, particularly with the use of AI. In order to properly implement AI in health care, it is important to make sure you have the right team:
    • Teams implementing AI need to have knowledge of AI, health care / health data, and clinical decisions—because on their own, they are all complex topics. Together, they are even more complicated and can clash if not integrated carefully.
    • Elahi likened this to a medical team—a patient would not want a top cardiologist performing their back surgery. In the same way, health tech needs to be built with teams that have a proper understanding of health care.
  • Transparency is off to a good start, however, has much farther to go in order to really bring meaning to patients and what they want.
  • Ideally, from an outside-the-beltway perspective, policy should follow what is already being done well in the private sector.
    • With that mindset, health innovators should try to shift away from reacting to new policies (ex. a new STAR measure) and rather, anticipate those changes by preparing and going beyond them.

 

Panel: Future of Health Care Policy

October 19, 2022 | 11:20 AM-12:20 PM

 Speakers:

Takeaways

  • There will likely be some uncertainty around mid-term elections, with run-offs in Georgia and potentially other states that will delay knowing exactly whether Congress flips to a Republican majority.
    • Voting is often driven off a fear of losing something. In 2017, the ACA was at stake. This year, it is abortion, which it’s hard to tell whether Democrats are putting too much weight on that subject.
  • No matter how the mid-terms turn out, there will be a decent amount of lame duck activity, which is typically driven by members wanting to leave legacies, taking care of things a new majority will not prioritize, or pushing through must-passes.
    • One of those must-passes will be a long-term government funding, which currently expires mid-December. Democrats will be pressured to address the debt ceiling and decide whether or not to extend it. This may delay the funding bill and could very likely extend the lame duck period all the way to Christmas Eve.
  • The debt and overall budgetary impact will likely have a significant role in health care, particularly as conversations about Medicare solvency and spending are rising.
    • In respect to MA’s original goals, MA successfully increased access to coverage but failed to decrease spending. MA spending is growing 9% annually, where FFS is only growing 6% annually.
  • With the recent MA scrutiny for overbilling, including the recent NYT article, the program will likely face scrutiny from Congress.
    • If the House flips, Hoagland pointed out that CMS / the administration as a whole will face increased oversight, which will include the MA program.
    • Jennings highlighted that Congress will likely try to avoid cutting any funding to the MA program as to avoid disruptions. However, it will likely focus on how to get more value out of each MA dollar, and if that fails, turning to budgetary actions.
  • To adapt to the changes brought by COVID-19, health care organizations should prioritize equity, technology, home-based care, and primary care integration.
  • The underlying pressures with the future of health care entirely lays in budgetary concerns and balancing growth in spending, innovation, and an aging population with not having enough money to pay for it all.
    • MA is far too entrenched to face significant cuts, however, it will be impossible to keep up with the program’s growth and spending without increasing revenues.
    • Jennings suggested that immigration reform is crucial to address this issue.

 

Breakout 3A: Addressing Behavioral and Mental Health Needs in Communities

October 19, 2022 | 1:00-1:55 PM

Speakers

Takeaways

  • The pressures of the workforce shortage are real, and this is particularly true for Medicare beneficiaries facing mental health challenges—42% of the physicians that opt-out of Medicare participation are psychiatrists.
  • BMA and ATI Advisory recently completed a research analysis regarding innovations in MA for mental health care, which has yet to be released. Key findings from the report:
    • The prevalence of mental health conditions does not change between MA and FFS beneficiaries, but the rates for both programs were significant—at least 1/3 of beneficiaries reported at least one condition.
    • In qualitative interviews with plans, system challenges identified in delivering mental health care included insufficient provider supply, coordination challenges, and a treatment focused culture.
      • Two policy issues highlighted included barriers created by state-specific licensures and the lack of funding for EHR implementation for behavioral providers under the HITECH Act.
    • MA has far more capabilities and flexibilities to provide mental health care than FFS. Also, beneficiaries in MA plans have better care coordination.
    • Innovations in care delivery center around prevention (e.g. supplemental benefits, team-based care), identification (e.g. screening, predictive analytics), and treatment (e.g. coaching, apps/digital platforms).
  • FindHelp operates a closed-loop referral platform that can integrate into different platforms, facilitates referrals to over 600,000 program partners, and then pushes social care notes directly into the electronic medical records. Chambers highlighted how better integration of social benefits / services will help build a stronger Medicare program.
  • Chambers highlighted a few primary challenges to successfully integrating social services into health care:
    • Information—oftentimes, beneficiaries do not know what is available to them, and can use FindHelp’s program to self-refer, or, more commonly, work with a provider to identify relevant services. In many circumstances, however, information beyond this referral is lost, which is why FindHelp operates the referral loop in order to link back to the providers and payers with information on outcomes.
    • Trust—many individuals have privacy concerns. FindHelp has an opt-in system for EHR integration, particularly for services delivered outside of the HIPAA ecosystem.
    • Complexity—most community-based organizations (CBOs) do not have the resources to implement complicated and expensive technical infrastructure. FindHelp then commits to keeping its services simple, cheap, and most important, interoperable.
  • In regards to the U.S. Preventative Task Force’s recommendation for annually screening adults 65+ for depression, this does create concerns about not having a workforce to address potentially newfound issues. However, having these conversations often and early may allow for interventions earlier and at a smaller scale before clinical interventions are needed.
    • For example, food insecurity may lead to immense stress which could lead to depression. However, if the food insecurity is addressed early some of that mental strain may be alleviated before it cascades to more serious conditions.
    • Integrated systems may be better at addressing this, as primary care providers may be in closer proximity to behavioral health providers.

 

 Breakout 4A: Affordability and Controlling Health Care Costs

October 19, 2022 | 2:00 – 2:55 PM

Speakers:

  • Matt Kazan, Managing Director, Avalere Health
  • Andrew Schwab, Vice President & Head of Government Affairs, Oak Street Health
  • Moderator: Greg Gierer, Vice President of Policy & Research, BMA

Takeaways

  • Due to CMS’ recent activity, it is expected and likely that there will be rulemaking and adjustments to the MA program, including risk adjustment.
    • It is no secret the administration prioritizes health equity, they may see MA, and particularly risk adjustment, as one policy lever to effect change.
    • For RAD-V audits, CMS does technically have a deadline so it is likely they will update the rule. However, CMS may also choose to ignore its own deadline.
  • MA’s payment model flexibilities allow MA plans to deliver supplemental benefits that are outside the traditional scope of care delivery. It includes things like meal benefits and support for caregivers.
  • Because Oak Street Health prioritizes primary care and providers take on full-risk, this both incentivizes affordability but also improves outcomes. This then saves the system money overall, but more importantly, brings costs down for beneficiaries.
    • Oak Street’s concierge model is highly popular among beneficiaries, with a Net Promoter Score of 90 out of 100.
  • Factors that contributed to the lowering of this year’s Part D premiums might include the number of $0 premiums on the market, in addition to the fact that the payment environment has been relatively stable during the pandemic due to little statutory/regulatory changes.
  • The biggest change from the Inflation Reduction Act for plans was the Part D redesign, which shifted some liability from the government to plans, with the catastrophic phase protections and OOP maximums. MA plans are likely able to better adapt to these changes than standalone Part D plans.
  • This year’s drop in Stars Ratings was likely due to prior policy changes in addition to the end of pandemic-related protections. However, this will give plans a chance to react and improve upon their Star Ratings for next year.

 

Breakout 5B: Addressing Hunger, Nutrition, and Health in Medicare

October 19, 2022 | 3:00 – 3:55 PM

Speakers:

Takeaways

  • Food is medicine—physicians prescribe diets daily, however people rarely think about how patients will access food to comply with those diets and whether they have access to food for those diets either.
    • Evidence shows that food makes a difference in health outcomes: this week, a JAMA Network Open study calculated that providing medically-tailored meals to beneficiaries with diet-related conditions could save up to $13.6B annually.
  • Mom’s Meals has over 100 meal combinations, which both is separated for different health conditions and also for different tastes, preferences, and cultures.
    • Recently, Mom’s Meals and UPMC piloted a program for D-SNP beneficiaries which delivered medically-appropriate meals for 13 weeks. The program led to a 36% reduction in ER visits.
  • While the recent White House summit on nutrition was monumental, the panelists agreed they wished there had been more a specific focus on seniors, as hunger faced by elderly people looks different that child hunger and interventions require different outcome measures. Additionally, the panelists wished that there were more specific policy changes from Congress, in addition to the added funding.
  • The panelists agreed that for successful payer-CBO partnerships, CBOs needed to meet payers where they were at in their nutrition journey, whereas payers needed to commit to long-term, consistent benefits for beneficiaries. Additionally, payers could help CBOs build the technical infrastructure required to participate in such a partnership.
  • Policy changes the speakers wished to see:
    • Recognition that food is healthcare.
    • Distinguish food benefits as an appropriately funded supplemental benefit.
    • Require payers to educate beneficiaries about the supplemental benefits they have access to, with the goal of increasing utilization.