Medicare Advantage Supplemental Benefit Flexibility
There is a general lack of financial resources, beyond the Medicaid program, to help individuals with complex care needs afford non-medical services and supports to remain independent in their homes and communities and avoid expensive hospital admissions and/or institutionalization. A promising start to covering this type of care through Medicare was recently enacted in the Bipartisan Budget Act of 2018, as part of the Chronic Care Act. This provision would allow Medicare Advantage (MA) plans greater flexibility in structuring and targeting supplemental benefits, so that plans could offer benefits to “maintain the health or function of chronically ill enrollees” that are not “primarily health-related.”
Through interviews with member plans, this project will identify challenges and barriers that MA plans face in including a supplemental benefit in their MA bid and preparing to launch it. LTQA will develop recommendations for statutory or regulatory changes, or modifications to the Call Letter and CMS guidance for the 2020 bid cycle, and communicate those recommendations in time to affect changes that would improve plan response in submitting a successful bid.
This project is funded by a grant from The SCAN Foundation.
Data Needs for the Adult LTSS Population Under 65
Much of our knowledge of the characteristics and needs of the LTSS population comes from studies of people age 65 and older, even though nearly half of the adult population with functional needs is under age 65. This gap in knowledge between the older and younger adult populations contributes to a disproportionate emphasis in LTSS policy and programming on older adults.
Through this research project, LTQA seeks to determine the specific gaps in information on the adult population under the age of 65 that uses LTSS and make recommendations to fill those gaps. This project will produce an Environmental Scan of data sources for adult LTSS users under age 65 and a White Paper describing data gaps, limitations of existing sources, and policy actions that can help close the gaps. This project is funded by a grant from The Commonwealth Fund.
Integrated Services and Supports for Residents of Affordable Senior Housing
In collaboration with LeadingAge Massachusetts and the West Health Policy Center, LTQA is in the final planning stages for a pilot project expected to launch in early 2018 to test a new model for integrating health care, LTSS, and affordable senior housing in the Greater Boston area of Massachusetts. The pilot brings Senior Care Option (SCO) health plans, PACE plans, and affordable senior housing communities together to develop and fund advanced in-building care coordination and preventive services.
Unique aspects of the integration model include:
- a mechanism to pool plan and building resources,
- solutions to enhance contact and communication between building residents, housing-based care managers, and the residents’ integrated health plans,
- innovative financing approaches.
LTQA is collaborating with the Center for Long-Term Services and Supports at UMass Boston to evaluate the impact of the project. The project is intended to produce materials that can help other communities replicate the model.
Measuring the Impact of Senior Care Options Plans
LTQA is currently engaged in a study, funded by the Blue Cross Blue Shield of Massachusetts Foundation, of the impact of the Massachusetts Senior Care Option (SCO) plans on medical utilization and outcomes for people who require LTSS. This is part of a larger body of work to study the impact of integrating LTSS with medical care for high-need populations, to support LTQA’s mission of expanding access to high-quality, person-centered LTSS.
This study of SCO plans consists of two parts:
- A detailed case study of each participating organization, examining the care model, organizational culture, provider network and relationships, and plan operations; and
- A quantitative study of the program’s overall impact on medical utilization, collaborating with Johns Hopkins University’s Roger C. Lipitz Center for Integrated Health Care to compare plan medical utilization to a national comparator “fee-for-service” population drawn from the National Health and Aging Trends Study (NHATS) matched Medicare file.
Developing the Business Case for LTSS
Phase 1: Developing a Framework for Measuring the Impact of Integrated LTSS
LTQA conducted a study to build the framework for developing the “business case” for integrating long-term services and supports (LTSS) and medical care. The study prepared a detailed definition (“Taxonomy”) of LTSS integration that described the components of integration and provided a scale of the degree of integration. LTQA completed case studies of 10 “exemplar” programs with experience in integrating LTSS and prepared a description and analysis of the various approaches and their potential impact on costs and quality. This preparatory study for developing the business case for LTSS integration established a framework for measuring (in a subsequent study) the impact of integration on overall health care costs and outcomes.
LTQA is grateful to the Gary and Mary West Foundation, The John A. Hartford Foundation, The SCAN Foundation, and the Commonwealth Fund for their support for this project.
Phase 2: Measuring the Impact of LTSS Integration on Medicare Utilization
Building on Phase 1 activities, LTQA conducted a study examining whether LTSS integration can significantly lower utilization of medical services for enrollees relative to what would be expected under fee-for-service Medicare. The study focused on five of the exemplar programs profiled by LTQA during Phase 1. The project yielded an estimate of the impact of more widespread adoption of integrated-care models on health outcomes and total health care spending.
LTQA is grateful to the Laura and John Arnold Foundation for their support for this project.