Medicare & Medicaid Program Design

ATI Advisory in partnership with the Rosalynn Carter Institute for Caregivers (RCI) sought to explore the evidence and needs of dementia caregivers that might inform a Medicare model test related to dementia care. On July 31, 2023, the Center for Medicare and Medicaid Innovation (CMMI) released the Guiding an Improved Dementia Experience (GUIDE) Model that includes explicit support for caregivers and is set to launch in July 2024.

ATI founder Anne Tumlinson shares her insights on the future of value-based care.

Part II: ATI's Fred Bentle sits down with Dr. Charles T. Pu to ask him about his experience operating a unique SNF at Home Model. Dr. Pu shares learnings from his SNF at Home trial, recently published in the Journal of Applied Gerontology.

Policymakers are calling attention to nursing home regulations clearly identifying owners and operators. We reviewed capital market dynamics, the role of private capital in the industry, and included policy implications for future reform.

Part I: ATI's Fred Bentle sits down with Dr. Charles T. Pu to ask him about his experience operating a unique SNF at Home Model. Dr. Pu shares learnings from his SNF at Home trial, recently published in the Journal of Applied Gerontology.

Healthcare providers are adapting in response to technologies enabling remote work, staffing shortages, patient preferences, and the competitive landscape of inpatient care.

ATI Founder, Anne Tumlinson, collaborated with long-term care industry leaders, Bob Kramer and David Grabowski, in this Opinion piece in The Hill on America’s failing long-term care infrastructure

The long-term care insurance market has been on a downward spiral due to several factors. Some carriers have exited the industry, and remaining carriers' policies are at much higher premium levels. This presents challenges to downstream policy.

Activity in both public and private sectors has revealed concerted movement toward establishing a long-term care model that is accessible to consumers and sustainable for state Medicaid funds.

ATI founder, Anne Tumlinson, testifies to on the Federal Commission on Long Term Care’s recommended changes to U.S. long-term care financing and delivery system.

On November 6, 2023, CMS released its Contract Year 2025 Medicare Advantage and Part D Proposed Rule [CMS-4205-P]. ATI Advisory prepared a summary of key provisions and insights across D-SNP and dual eligible impacts, supplemental benefits, Part D formularies, network adequacy, agent and broker commissions, and equity-related provisions. The Rule has a heavy focus on beneficiary protections and program transparency.

Understanding differences in Medicare beneficiary experiences by race and ethnicity across Medicare Advantage and FFS Medicare can help policymakers and business leaders identify opportunities for health equity and continual improvement across both pathways to Medicare coverage.

An ATI Advisory analysis commissioned by Better Medicare Alliance found that Medicare Advantage beneficiaries report saving more than $2,400 annually on out-of-pocket costs and premiums compared to Fee-for-Service (FFS) Medicare beneficiaries.

Analysis of national Medicare Advantage enrollment data between 2022 and 2023 shows that Medicare Advantage gained more than two million enrollees, reaching more than 47% of the Medicare eligible population. Medicare Fee-For-Service enrollment data showed 800,000 fewer enrollees over the same period.

Anna Kaltenboeck recently penned a Health Affairs article that explains how the Inflation Reduction Act will affect Medicare Part D and prescription drug pricing.

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.

With support from Arnold Ventures, ATI Advisory identified two near-term opportunities to update the Medicare Plan Finder tool to improve its utility and reduce confusion for individuals who are dual eligible.

An analysis of nonmedical supplemental benefit offerings in metro and non-metro areas found that 42% of metropolitan MA plans offer these benefits compared to 34% of rural MA plans. While the presence of benefits does not equate to access, this databook points to the need for additional research on utilization of benefits to examine any issues with equitable access across metro and non-metro counties.

Medicare Advantage (MA) plans are able to offer additional benefits over the benefits all Medicare beneficiaries receive – called supplemental benefits. These supplemental benefits most typically take the form of vision, dental, hearing, and medical transportation services, but the types of benefits offered are evolving rapidly to include things like in-home support services or personal care, food, and help paying utility bills. Improving data available on these supplemental benefits in MA is clearly on the minds of officials at the Centers for Medicare and Medicaid Services (CMS).

Four years into implementation, nearly 40% of Medicare Advantage plans are offering nonmedical supplemental benefits in 2023. This latest 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.

On November 6, 2023, CMS released its Contract Year 2025 Medicare Advantage and Part D Proposed Rule [CMS-4205-P]. ATI Advisory prepared a summary of key provisions and insights across D-SNP and dual eligible impacts, supplemental benefits, Part D formularies, network adequacy, agent and broker commissions, and equity-related provisions. The Rule has a heavy focus on beneficiary protections and program transparency.

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.

With support from Arnold Ventures, ATI Advisory conducted listening sessions, focus groups, and interviews with diverse stakeholders to better understand the unique needs and experiences of individuals who are dual eligible for Medicare and Medicaid, and their caregivers. Through these conversations, ATI gained insights on the potential role that integrated coverage and care experiences can play in addressing the concerns of individuals who are dual eligible and their caregivers. Central to what we heard: individuals who are dual eligible and their caregivers seek a person-centered and seamless consumer experience.

Part 2 in the Health Affairs series co-authored by Allison Rizer focuses on policy opportunities for Medicare-Medicaid integration to benefit dual eligible individuals.

Allison Rizer co-authored this series in Health Affairs focusing on policy opportunities for Medicare-Medicaid integration to benefit dual eligible individuals.

The shortage of worforce capacity to deliver services to beneficiaries limits the ability of state Medicaid agencies to provide services. States have three core options to encourage managed care entities to support HCBS capacity building efforts.

Medi-Cal allows managed care plans to provide flexible person-centered services and address social drivers of health. Other states across the country can look to California’s experience to explore opportunities to leverage ILOS more broadly.

CA's Medicare Innovation Office is the first dedicated office within a state Medicaid agency focused on program design for dual eligibles. Understanding the growing Medicare population is important for CA to identify opportunities to support them.

This report outlines strategic recommendations for the California Department of Aging to explore in its effort to improve quality, equity, and cultural competence. Other states and their SHIPs might also consider these recommendations.