Star Ratings, SDoH, supplemental services: A Q&A with Robert Pittman, SVP of Government Affairs

In 2022, many Medicare Advantage (MA) plans added several supplemental services to their offerings, including meals, non-emergency medical transportation and personal care. This year, 68% offer meals, 39% transportation and 11% in-home supportive care. These numbers are across-the-board increases in each area compared to 2021.

Medicare Advantage plan enrollment continues to increase, as well. In 2021, approximately 26 million people, or 42% of the total Medicare population, were enrolled in a Medicare Advantage plan. The number of Medicare Advantage participants has grown steadily since 2004.

To better understand the impact of Medicare Advantage plans and the supplemental services they offer for the plans themselves as well as plan participants, we asked Robert Pittman, SVP, Government Affairs at Modivcare, a few questions.

Question: Medicare Advantage plans continue to expand supplemental coverage, including in-home support services, meals and non-emergency medical transportation. Why are extra supportive care services like meals, transportation and in-home care important to plan participants?

Answer: Supplemental care services offered by MA plans are important to plan participants as a means to help enhance their quality of life by improving health or functionality and thereby allowing them to age independently. Access to transportation, in particular, has been identified as a key social determinant of health (SDoH). SDoH are requisites for good health for the Medicare population.

Question: What does the expansion of supplemental services say about the viability of Medicare Advantage plans over the next few years?

Answer: The recent growth in MA suggests that Medicare beneficiaries have noticed and like the additional supplemental benefits. However, the plans must be wary of adding these benefits without a proven return on investment. Medicare Advantage was developed to save money for the Medicare trust fund by managing beneficiaries' care, but the government pays plans 104 percent of the fee-for-service costs. The plans are showing that the supplemental services are improving health outcomes in the long term and thereby saving money for Medicare through partnerships with organizations like Modivcare.

Question: How do supportive care solutions help Medicare Advantage plans maintain or improve Star Ratings?

Answer: Most of the Star Ratings inputs relate to accessing care: a percent of beneficiaries receiving a certain service (flu shot, breast cancer screening). Non-emergency medical transportation supplemental services can directly improve those measures by ensuring the beneficiary gets to the service provider. Other Star Rating measures are harder to directly connect to the supplemental benefits, but the potential for improvement is highly suggestive. For instance, meal delivery or structural home modifications could improve the plan’s ratings for “avoiding hospitalizations for potentially preventable complications.” Gym memberships and home-based palliative care could improve “physical functioning activities of daily living.”

Question: What are a few of the newer supportive care services that Medicare Advantage plans are offering?

Answer: Since the expansion of supplemental services, many plans are offering in-home support services, food and produce, meals beyond a limited need, transportation for non-medical needs and pest control. Companies like Modivcare offer integrated home and community-based services including transportation, meal deliveries and in-home personal care services.

Question: Why is it important for healthcare organizations like Modivcare to offer services to Medicare Advantage plan participants?

Answer: Working with organizations like Modivcare ensures the plan receives the most return on investment for their supplemental benefits. These organizations have a history of providing high-quality services with business processes to track the services, ensure the safety of the vehicles being used or the quality of the food being delivered, and certify the trustworthiness of the person providing the services in the beneficiary’s home through compliance with electronic monitoring of home-based services.

Question: Do you anticipate that Medicare Advantage plans will continue to add supplemental services? What might those be?

Answer: Services that address SDoH such as safe housing, broadband access, programs to address social isolation, in-home personal care services for beneficiaries with limitations in their activities of daily living, including assistance with transferring, toiletries, personal hygiene, dressing and eating.