Advancing Nonmedical Supplemental Benefits in Medicare Advantage

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ATIWork
02/02/2024
AUTHOR – ATI Advisory

Since 2019, ATI Advisory and the Long-Term Quality Alliance, with support from The SCAN Foundation, have led national efforts to advance person-centered, non-medical supplemental benefits in Medicare Advantage. This resource center provides research and data for plans, providers, beneficiary advocates, policymakers, and other stakeholders to advance understanding and utilization of these benefits. All of our research is guided by the Supplemental Benefits Leadership Circle, a diverse group of experts across plans, providers, academia, and advocacy groups.


RECENT

An Evaluation Framework for Assessing Nonmedical Supplemental Benefits in Medicare Advantage


Data on Nonmedical Supplemental Benefits


2024

Chartbook: 2024 Nonmedical Supplemental Benefits in Medicare Advantage

2023

Chartbook: 2023 Nonmedical Supplemental Benefits in Medicare Advantage

Data Insight: Expanded Primarily Health-Related Benefits in Plan Year 2023

Metro and Non-Metro Medicare Advantage Plan Offerings of Nonmedical Supplemental Benefits Databook

2022

Chartbook: 2022 New, Non-Medical Supplemental Benefits

Data Insight: Growth in New, Non-Medical Benefits Since Implementation of the CHRONIC Care Act

2021

Chartbook: 2021 Special Supplemental Benefits for the Chronically Ill

Data Insight: Special Supplemental Benefits for the Chronically Ill in Plan Year 2021

Chartbook: 2021 Expanded Primarily-Health Related Benefits

Data Insight: New Primarily Health-Related Benefits in 2021 Medicare Advantage Plans

2020

Chartbook: 2020 SSBCI and New Primarily-Health Related Benefits

Data Insight: Meeting Medicare Beneficiary Needs During COVID-19: Using Medicare Advantage Supplemental Benefits to Respond to the Pandemic


Implementation Roadmaps & Research


Four years into implementation, nearly 40% of Medicare Advantage plans are offering either expanded primarily health-related benefits (EPHRB) or Special Supplemental Benefits for the Chronically Ill (SSBCI) in 2023. This latest report, guided by the SSBCI Leadership Circle and produced by ATI Advisory and LTQA, builds on prior research in 2020 and 2021. This report examines why benefits that help members stay in their homes – specifically in-home support services (IHSS), caregiver supports, and social needs benefits – have experienced significant growth and adoption despite the challenges in providing a human-powered service.

This latest report includes extensive data on these three benefits as well as recommendations for plans, providers, and policymakers to support more Medicare beneficiaries in having access to benefits that can meaningfully meet their needs and are delivered in alignment with the Guiding Principles.


2023

A Deep Dive on In-Home, Caregiver, and Social Supports in Medicare Advantage: Can These Benefits Meaningfully Meet Member Needs and Support Independence?

2021

Delivering on the Promise of the CHRONIC Care Act: Progress in Implementing Non-Medical Supplemental Benefits

2020


Policy Recommendations


After five years of growth of nonmedical supplemental benefits, there are significant gaps in our knowledge and the data around these benefits, especially from the perspectives of Medicare beneficiaries. Action must be taken to close data gaps so that policymakers have the information necessary to assess and, if needed, refine these benefits to align with their original intent to support the needs of individuals with complex chronic conditions. 

ATI Advisory and Long-Term Quality Alliance, with support from the SCAN Foundation, created the Evaluation Framework to chart a path for multiple stakeholders – including plans, policymakers, and researchers – to provide timely insights on Medicare Advantage enrollee needs, understanding, access, and experience of benefits; to enhance plan capabilities to collect and use data to improve benefit offerings; and to build the evidence base on nonmedical benefits’ effects.


2024

An Evaluation Framework for Assessing Nonmedical Supplemental Benefits in Medicare Advantage

2022

Fulfilling the Promise of the CHRONIC Care Act: Policy Recommendations to Advance New Supplemental Benefits in Medicare Advantage

Top Recommendations for Congress to Advance New Supplemental Benefits in Medicare Advantage

2021

Delivering on the Promise of the CHRONIC Care Act: Policy Recommendations for the Administration to Advance Non-Medical Supplemental Benefits

2020

Advancing Non-Medical Supplemental Benefits in Medicare Advantage: Considerations and Opportunities for Policymakers


Background & Other Resources


The past few years have provided Medicare Advantage Organizations (MAOs) with the opportunity to experiment with unprecedented flexibility to address the non-medical needs of their enrollees. MAOs are increasingly embracing this flexibility and leveraging it to provide care to their members that meets individual need, which has been especially valuable during the continued public health emergency.

There are a number of legislative changes that Congress can undertake to advance these benefits. Based on several years of research tracking the initial implementation and progress of these new supplemental benefits, we have developed three key policy recommendations for Congress to consider to advance new supplemental benefits in Medicare Advantage. The recommendations have the potential to improve access to these benefits, as well as increase visibility into how these benefits are being received and their impacts.


Guiding Principles for Nonmedical Supplemental Benefits in Medicare Advantage

A Turning Point in Medicare Policy

Chronic Care Act: Making the Case for Non-Medical Services and Supports in Medicare Advantage Supplemental Benefits

Non-Medical Supplemental Benefits FAQ

LTQA Webinar (Part 1) Recording: Advancing Non-Medical Supplemental Benefits in Medicare Advantage

LTQA Webinar and Panel (Part 2) Recording: Advancing Non-Medical Supplemental Benefits in Medicare Advantage

CY 2023 Medicare Advantage Proposed Rule: Impacts on Non-Medical Supplemental Benefits

SSBCI Leadership Circle Members
November 2023

Recent Work

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State Resource Center

ATI Advisory is pleased to release these first resources as part of our State Resource Center. We will continue to release state resources reflecting the latest insights and novel strategies, tip sheets, and education on the ever-changing market and federal policy environment, and what it means for states.
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Work

An Evaluation Framework for Assessing Nonmedical Supplemental Benefits in Medicare Advantage

After five years of growth of nonmedical supplemental benefits, there are significant gaps in our knowledge and the data around these benefits, especially from the perspectives of Medicare beneficiaries. Action must be taken to close data gaps so that policymakers have the information necessary to assess and, if needed, refine these benefits to align with their original intent to support the needs of individuals with complex chronic conditions. ATI Advisory and Long-Term Quality Alliance, with support from the SCAN Foundation, created the Evaluation Framework to chart a path for multiple stakeholders – including plans, policymakers, and researchers – to provide timely insights on Medicare Advantage enrollee needs, understanding, access, and experience of benefits; to enhance plan capabilities to collect and use data to improve benefit offerings; and to build the evidence base on nonmedical benefits’ effects.
Read More Read More
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Opportunities to Advance Nursing Facility Quality of Care Through Medicare-Medicaid Integration 

This issue brief explores the attributes of a potential Medicare-Medicaid integrated model focused on ensuring high quality and high value care for dual eligible long-stay nursing facility residents. We identify policy opportunities for CMS and states to consider to facilitate a Medicare-Medicaid model in nursing facilities, including increasing payment transparency, promoting alignment between Medicare and Medicaid quality measures, and requiring that a percentage of plan payment go towards value-based contracts with nursing facilities. Taken together, these model elements could meaningfully improve experiences for dual eligible individuals living in nursing facilities, and for their families.
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