A new focus on expanded benefits
CMS recently made changes to the types of benefits that MA plans can offer. Once limited to a short list of supplemental benefits, MA plans will have the ability to offer coverage for any goods and services that reduce avoidable emergency department visits or are used to diagnose, prevent, or treat injuries or health conditions.

Going forward, MA plans will be able to offer a wide array of supplemental programs, enabling them to promote overall patient health rather than merely provide care when patients are sick. These new benefits may include a broad range of services, such as therapeutic massage, smoking cessation, in-home support, transportation to medical services and caregiver support.

In addition, plans can offer reduced cost-sharing and additional benefits tailored for enrollees with certain conditions, such diabetes and congestive heart failure. Currently only 270 of the 3,600 overall MA plans are offering these new categories of benefits, but CMS expects more plans to take advantage of this enhanced flexibility with expanded features in the future. CMS also recently approved additional new options, such as covering the cost of fresh produce for patients with heart disease or carpet cleaning for those with asthma.

Taking an innovative and collaborative approach to preventive care
Due to their incentive structure, MA plans have much more motivation than traditional FFS plans to make investments in preventive care. In many cases, this prevention should come in the form of better primary care, such as benefits that provide access to case workers or social workers that can help patients solve needs related to social determinants of health.

Other benefits that can encourage greater use of preventive care include zero copays for visits with primary care physicians or low- or no-cost screenings for breast cancer, colorectal cancer or diabetic eye exams, for example.

For MA plans to be successful, a collaborative approach is essential. True collaborative payers can deliver improved clinical and financial outcomes and an enhanced consumer and provider experience by pursuing the following characteristics. All provider network participants are aligned through shared financial incentives to reduce costs and improve quality. They leverage data and analytics to discover opportunities to improve care or reduced costs by analyzing all available information around utilization, access, setting, cost and quality.

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