Healthify Blog

CMS Updates Medicare Advantage Payment Policies, What It Means for SDoH

New supplemental benefit coverage may help address SDoH amongst seniors

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) finalized new Medicare Advantage payment policies for 2020 that will increase competition among health plans, so patients receive higher quality care at lower costs. The changes announced by CMS will increase plan choices and benefits, allowing seniors the option to choose Medicare Advantage plans that offer supplemental benefits customized to their specific needs. Additionally, the new policies will also give chronically ill patients with Medicare Advantage plans access to a range of supplemental benefits that aren’t exactly health-related, but may improve or maintain their overall health.

Topics: social determinants of health Medicare elderly

Using Dual Eligible Plans to Improve Care for our Most Costly Patients

Dennis Heaphy, a Boston resident and 30-year quadriplegic, received new health care coverage in 2014. As part of initiatives ushered in with the Accountable Care Act, Heaphy, a low-income disabled individual, was able to stay home and in his community. This was a drastic change from the expensive and disruptive alternative he was all too familiar with—frequent visits to the hospital and long-term stays at skilled nursing facilities.

Now, improvements are being tested in a pilot program—“dual eligible” plans—aimed at providing better coordinated care for patients like Heaphy, who is among a group of the most costly and complex patients.  

Topics: Medicaid coordinated care ACA Medicare dual eligibles elderly