Radar on Medicare Advantage
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News Briefs: New Research Shows Rise in Telehealth Use Among Medicare Enrollees| Dec. 16, 2021
New statistics showing a rise in telehealth usage among Medicare beneficiaries during the pandemic make a strong case for permanently expanding telehealth coverage for Medicare patients. A new report from the HHS Assistant Secretary for Planning and Evaluation (ASPE) found that the number of FFS beneficiary telehealth visits rose from approximately 840,000 in 2019 to nearly 52.7 million in 2020, with the largest increase seen in behavioral health specialist visits. Black and rural beneficiaries demonstrated lower use of telehealth compared with white and urban beneficiaries, respectively. The report did not include results for Medicare Advantage members, since plans had discretion to offer telehealth prior to the pandemic, noted ASPE. Meanwhile, a new Medicare Telemedicine Data Snapshot from CMS showed that the number of Medicare beneficiaries (including MA enrollees) using telemedicine services between March 1, 2020, and Feb. 28, 2021, increased over 30 times the number of users from the prior year (March 2019 to February 2020). Dual eligibles had higher use of telehealth than those with just Medicare. “These latest numbers prove that when given the resources and opportunity to use telemedicine, many of these patients will opt to use the technology,” wrote Connected Nation, which seeks to fill broadband and digital technology gaps through partnerships across all sectors. “We would argue that among the critical needs is to expand not only access to broadband but also working to ensure it is affordable and that others understand both how to access the technology and how it can benefit them.”
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In AEP Home Stretch, MAOs Make Final Push for Enrollment
With a bevy of plan options and supplemental benefits available to seniors and the omnipresence of multicarrier brokers, regional Medicare Advantage organizations are working doubly hard to get in front of potential and existing customers during this final stretch of the 2022 Annual Election Period (AEP). Complicating their efforts are continued slowdowns with mail delivery, which could impact brochures getting to Medicare-eligible beneficiaries before the AEP ends on Dec. 7, according to marketing experts.
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Expecting Hot Medicare AEP, E-Brokers Beefed Up Internal Sales Forces
As the Medicare Annual Election Period (AEP) was in full swing last month, electronic marketing organizations (EMOs) like eHealth, Inc. and GoHealth, Inc. saw increased traffic to their online marketplaces and improved use of other digital tools. But both publicly traded firms, which posted third-quarter 2021 earnings in early November, have reported trouble converting telesales into enrollments and retaining members from the prior year — an area that is often seen as a weak spot for carriers that work with the large brokers.
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Recent MA Coding Complaints Signal DOJ’s ‘Evolving Expectations’
The risk adjustment system used to pay Medicare Advantage plans continues to face intensifying scrutiny from the federal government, with the Dept. of Justice (DOJ) intervening in multiple False Claims Act (FCA) complaints and the HHS Office of Inspector General focusing on retrospective chart reviews and high-risk diagnosis codes. Now, attorneys say health care providers should be on high alert as well. While prior DOJ complaints-in-intervention have focused largely on MAOs conducting “one-way” chart reviews, more recent lawsuits focus on the use of “addenda” — information retroactively added to a patient’s medical record — which one law firm says indicates a new area of scrutiny.
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As Supplemental Benefits Rise, In-Home Services Skyrocket in ’22
CMS’s reinterpretation of “primarily health-related” benefits has led to more Medicare Advantage plans offering services such as in-home support services, home-based palliative care, support for caregivers and therapeutic massage for the upcoming plan year, according to a new analysis from Milliman. The number of MA plans that will offer one of five selected benefits grew 43% from 2021, to 824 plans, while 202 plans will offer at least two of the benefits next year, up from 175 plans in 2021. Notably, the number of plans offering in-home support skyrocketed from 296 in 2021 to more than 500 in 2022. Of the five studied benefits, only adult day health services will see a decline in availability next year.
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