CMS recently published an update on its Medicare value-based care strategy that anchors on three pillars: alignment, growth and equity. Notably, CMS calls on MA plans to use supplemental benefits to create value, and lean into the shift to value-based care.
This call to action, in tandem with heightened reporting requirements, is an exciting moment for health plans to shift from member acquisition through differentiated benefits to leveraging those same benefits for savings and outcomes improvements.
- Alignment with Value-Based Care Models: CMS is increasing pressure to hit its target of 100% of lives involved in some form of value-based care arrangement by 2030. Cited drivers, of course, include quality improvement, efficient spending, and better visibility. CMS is calling for all stakeholders to understand and support value-based care models to reduce administrative burden for providers and ensure effective healthcare delivery transformation.
- Expansion of Accountable Care Relationships: MA plans need to expand accountable care relationships to enhance person-centered care, care coordination, and cost reduction. Targeting underserved communities is crucial to address health disparities and promote equitable access to quality care.
- Mirroring the Shared Savings Program: MA plans should consider their approach, and that of the provider ecosystem, to the Shared Savings Program. Recognizing that initiatives such as advance investment payments for smaller ACOs have driven engagement, particularly in underserved areas, plans have an opportunity to adopt or support similar practices.
- Strengthening Primary Care Infrastructure: MA plans can strengthen primary care infrastructure, potentially through models like the Making Care Primary Model. This involves offering prospective payments and new codes to facilitate innovative care delivery and improve access to primary care services.
- Quality Improvement Initiatives: MA plans should prioritize quality improvement efforts, aligning with Merit-based Incentive Payment System (MIPS) measures and focusing on targeted measure sets to drive accountable and value-based care. This is essential for improving health outcomes and patient satisfaction.
- Integration of Social Determinants of Health: MA plans should integrate social determinants of health into care plans and supplemental benefits offerings. This includes addressing unmet social needs such as food insecurity, housing instability, and transportation barriers.
- Transparency and Accountability: MA plans need to ensure transparency and accountability in the provision of supplemental benefits. Collecting data on benefits usage and demonstrating health impacts can promote informed decision-making among enrollees and foster robust market competition.
By offering valuable supplemental benefits that align with CMS goals, MA plans have a massive opportunity to lead the way towards better outcomes and satisfaction for their members. Dina’s health plan partners are on the leading edge of improving access, standardizing high-quality networks of vendor and service providers, and tracking performance to get ahead of emerging compliance requirements.
MA Plans are Booming:
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Download our report “Home Benefits Surge in Popularity Among Medicare Advantage Plans” to learn more about leveraging supplemental benefits to increase member satisfaction, retention and STARs.
