Blog Post | December 3, 2018

Creating the Buzz Around Supplemental Benefits


Turn-Key’s expert AHIP Panel initiated some thought-provoking discussion about non-medical supplemental benefits coverage, igniting a reporter from Modern Healthcare who was in the audience to publish a follow-up article.

Clearly, when the Centers for Medicare & Medicaid Services (CMS) loosened reimbursement limitations on home healthcare and home-based palliative care, these issues became high-profile areas for accelerated discussions and continued coverage.

Perspectives from the Panelists

Andrew MacPherson, principal at Healthsperien, senior policy advisor, Coalition to Transform Advanced Care (CTAC), explained that this is the first time real value has been placed on palliative care by CMS – and more specifically on home-based, community-based palliative care (CBPC).

MacPherson is also quoted in the MH article: “When a model of care is fully responsible to one’s goals, values and wishes and objectives in care and life, they tend to receive higher-quality care in the home, the setting of choice…and just as a bonus, it tends to save money because you are avoiding hospital admissions that the person didn’t want in the first place.”

David Sand, M.D., MBA, chief medical officer, Care N’ Care Health Plan, shared an experience with his organization’s adoption of palliative care saying, “We found much earlier referral to hospice and tremendous satisfaction and gratitude amongst our members and their families with net promoter scores hovering around 90 percent.”

Optimizing Home-Based Care

By giving MA plans greater flexibility to expand existing coverage, CMS has taken a significant step forward to increase broad support of home-base palliative care and innovative solutions designed to optimize care for patients and families across the country.

Despite the complexity of this vulnerable population, MacPherson emphasizes the key to increasing patient satisfaction and outcomes is to place focus on the patient and family.

“The whole idea is to ensure individuals are in the setting of their choice, and this population’s preference is to receive care in the home,” he told MH.

Here’s an Update…If you missed the recent AHIP 2018 National Conferences on Medicare, Medicaid and Duals Expert Panel

The Turn-Key-hosted panel discussion featured market experts with a dedication to and an understanding of the impact of recent changes from CMS.

Moderated by Greer Myers, president, Turn-Key Health, the panelists  included:

Participants heard from the panel what is likely to unfold now that CMS has added more flexibility to its policies for the Medicare Advantage (MA) program and expanded the supplemental benefits to include items and services related to social determinants of health (SDOH).

Hands down, there was consensus that there would be tremendous opportunities going forward for interaction with the non-medical aspect of CBPC.

Key takeaways:

  • A groundswell of stakeholder and government support has pushed innovation, helping MA plans meet the needs of members with a serious or advanced illness
  • Community-based palliative care for MA members can have a dramatic impact on care quality and member satisfaction, while curbing costs
  • Implementing community-based palliative care programs requires the ability to identify members within six to nine months prior to death to see positive ROI
  • Effective palliative care programs witness tremendous satisfaction among members and their families, with net promoter scores hovering around 90 percent and PMPM savings between $2,000-$3,000
  • Success depends upon building in-depth communication with the members and caregivers as led by nurses, social workers and experts with clinical experience and specialized palliative care training
  • Teams of clinical specialists form an important connection between the patients and network providers, building trust and support for the program

 


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