Socially Determined’s Post

The combination of better care at lower costs has made #medicareadvantage (MA) an increasingly popular choice for beneficiaries. In fact, MA is now the preferred coverage option for over half the Medicare population. Given the clear spike in seniors’ care utilization that is widely expected to continue into next year, It's vitally important that final MA policies for 2025 ensure stability in benefits and costs for these 32 million beneficiaries. https://lnkd.in/ek977HUa

“The average Medicare beneficiary living in a rural community has a selection of 27 MA plans to choose from, up from 19 in 2010. Metropolitan residents have 46 plans to choose from in 2023, compared to 32 in 2010.” Know what you’re giving up when choosing a Medicare “Advantage” plan. https://lnkd.in/etiUj_pu #medicareadvantage #medicare #medicareinsurance #medicarepartb #medicareplans #healthinsurance #healthinsuranceplan #medicareenrollment

Medicare Advantage may be the more popular plan option for seniors, but its geographic disparities are evident in the choices and quality of care that many seniors are subject to, depending on where they reside. Communities of color with high poverty rates did not have full access to high-rated Medicare Advantage plans when compared to wealthier areas with a majority of white residents. Medicare availability is directly affected by geographic quality differences. The government uses many different factors to measure quality when it comes to rating Medicare Advantage on a 5-star scale, with those in disadvantaged areas not likely to find care at a 4.5 or higher rate. By 2027, the Centers for Medicare and Medicaid have planned to change their star rating bonus program by rewarding plans that improve and provide care for disadvantaged populations. Lawmakers and the current administration have changed their methods of evaluating Medicare Advantage plans after reports of overuse of preauthorization requirements, damaging marketing schemes, and manipulation of data. #Medicare #RuralHealthcare #SeniorHealthcare #HealthDisparities #HealthInsurance

Medicaid programs - with support from CMS - are increasingly likely to consider the impact of the social, environmental and economic factors on the health of their enrollees. This makes good sense given the impact of these factors on preventable illnesses and injuries and the subsequent costly health care expenditures. In many states the specifics on what will get paid for and for whom are still getting worked out. And health care systems by themselves can't be expected to bear the burden of addressing the social determinants. But together with the housing, food, transportation, business, education and public health sectors, they have a role. So, kudos to CMS for allowing consideration of these options and kudos to the states that are pushing the boundaries.

Our recently published study in JAMA Network Open found that the quality star-rating of Medicare Advantage plans is lower in highly socially vulnerable counties. What this means is that Medicare beneficiaries living in counties with greater social disadvantage have fewer opportunities to enroll in highly rated MA plans. The quality ratings of plans also determine their quality bonus payments, which can translate into better supplemental benefits for beneficiaries. Our findings imply that beneficiaries who might benefit the most from supplemental benefits, might not have access to plans with highest financial resources to fund such benefits. Such a pattern of star rating and county-level social vulnerability could exacerbate inequities in health care access, experience and outcomes. Glad to have authored this with my excellent mentors: Jose Pagan Diana Silver Sherry Glied David J. Meyers, PhD Check out our study here: https://lnkd.in/e4fHM5S3 and this excellent coverage by the US News & World Report. https://lnkd.in/eS8rm77V

If #Medicaid spends on #erectiledysfunction then paying for #foodasmedicine makes a lot of sense. As a #pediatrician in Medicaid I spent way more time reviewing #priorauthorization for aging men to stay “virile.” Meanwhile a simple thing like vaginal estrogen for #vaginalhealth could help aging women not get UTIs, not get urosepsis, and not die… as well as still have non-painful intimacy in marriage or relationships. Who determines the rules of what gets funded? When I look at how much viagra Medicaid pays for while denying certain types of #cancercare, you can immediately see who holds the purse strings and their priorities and for whom they have “#empathy.” I do not begrudge aging men feeling youthful or having full lives. I’d like grandmothers, babies, mothers to be as valued or offered #health, #wellbeing, and #qualityoflife.

The focus on dually eligible beneficiaries - people who have both Medicare and Medicaid - is very needed in order to better manage your population and improve health outcomes. This infographic from CMS shows the differences in number of chronic conditions and need for assistance with activities of daily living (ADLs) between dually eligible and Medicare-only populations. Understanding that both MSSP ACO and ACO REACH have adjustments for serving underserved patients allows for the investment into the practice's infrastructure. Understanding your population is key an Acclivity can help you! https://okt.to/3d6fin

"Georgia Pathways, a state program providing health coverage to certain low-income people, was always expected to underperform compared to a true Medicaid expansion, in terms of how many people would be helped. But even supporters didn’t expect the program to be this limited: as of mid-December 2023, roughly six months into the program, a scant 2,344 people had enrolled.... Meanwhile, a true Medicaid expansion to people with incomes up to 138 percent of the poverty level (or about $20,000 annually for an individual), free of work verification requirements, would make 434,000 Georgians newly eligible for Medicaid — with the federal government picking up 90 percent of the cost and providing $1.2 billion over two years in additional federal funding. It would also bring a number of proven health and economic benefits, such as protecting people from significant medical debt and giving a boost to rural hospitals. As state lawmakers convene this year and consider ways to increase access to health coverage, they should consider a full Medicaid expansion." #MedicaidExpansion #MedicalDebt #HealthEquity #HealthcareAccess https://lnkd.in/e7q5RY_G

Dual eligibles have unique health profiles compared to Medicare-only beneficiaries. However, while dual eligibles experience many similar hardships, they should not be treated as a homogenous group; among community-dwelling Medicare beneficiaries, 35% of dual eligibles are under age 65 and qualify for Medicare on the basis of disability rather than age. Therefore, it's easy to question whether comparisons between Medicare-only beneficiaries and dual eligibles are accurate across the board. Graph A demonstrates that dually eligible Medicare beneficiaries experience significantly more functional limitations than individuals receiving Medicare alone. Although dual eligibles under age 65 experience more functional limitations than their 65+ counterparts, as expected, graph B also illustrates that older dual eligibles still experience significantly more functional limitations than Medicare-only beneficiaries. It's worth noting that these numbers represent community-dwelling Medicare beneficiaries, and that institutionalized Medicare beneficiaries likely experience higher rates of functional limitations. DSNPs can provide dual eligibles with the support they need to live healthier, more dynamic lives. Many DSNPs include benefits such as in-home care and transportation services that the beneficiary would otherwise be unable to afford. We are proud to connect dual eligibles with the benefits they need and deserve. We will be sharing more insights soon, so stay posted! Source: https://lnkd.in/eWrkKQip #WhoWeServe #DSNP #DualEligible #Medicare

As the Medicare population continues to grow, so do the number of Dual Eligibles. Duals make up about 17% of the Medicare population but account for approximately 33% of Medicare spend. Interesting article on this complex and costly population and how coverage is applied and managed. https://lnkd.in/eYscxhYB