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 1. All Episodes
 2. EP291: What Are Medicare Advantage Plans Up to Right About Now? With Betsy
    Seals, Cofounder of the Rebellis Group


EP291: WHAT ARE MEDICARE ADVANTAGE PLANS UP TO RIGHT ABOUT NOW? WITH BETSY
SEALS, COFOUNDER OF THE REBELLIS GROUP



Sep 10, 2020



Medicare Advantage (MA) enrollment has nearly doubled over the past decade. It
grew 37% from 2016 to 2020. Right now, MA comprises nearly 40% of the Medicare
population—and that number is only expected to grow.

So, in case you’ve been out of the loop, at the beginning of 2020, CMS (Centers
for Medicare & Medicaid Services) rolled out a third category of these “chronic
supplemental benefits.” And these chronic supplemental benefits allow plans to
offer basically services to attenuate social determinants of health to offer
stuff like nonemergency transportation, meals, home modifications … that whole
list.

This is all, really, part of a broader bipartisan effort to move Medicare from
an acute care to a chronic care program. Then … corona.

So, the question I’m kind of wondering about at this juncture is, Were/Are MA
beneficiaries able to maintain their health status better than, say, other plan
designs, especially given some of these chronic supplemental benefits, which
you’d think would be super helpful in the middle of a pandemic?

This should make sense, and it should really be true. At its core, MA is, as
John Gorman put it when he was on the show last year, the biggest value-based
payment experiment in the universe. And patient outcomes have definitely
improved for MA patients over traditional FFS (fee for service), especially in
the south and in other areas rife with cardiovascular and metabolic disease. So,
that sounds great.

Now let’s talk about the cash money denominator in the value equation. Humana
reported $1.8 billion in profit for the second quarter. That was nearly double
its haul in Q2 2019. So far, 2020 has seen a profit that is a 94.5% increase
year over year. Humana’s earnings are not an outlier. MA plans across the board
did very well, thank you very much, in the middle of a pandemic.

Given that MA hasn’t actually reduced PMPM (per member per month) costs last
time I looked at it, you’d think and hope that the confluence of higher rates
and less restrictions on extra benefits should definitely lead to greater
scrutiny on the plans by CMS. We’ll see what happens.

Anyway, it occurred to me that it might be interesting to get a bead on what MA
plans themselves have been contemplating and thinking about relative to the
supplemental benefits et cetera. In this health care podcast, I speak with Betsy
Seals, cofounder of the Rebellis Group. Betsy spent many years working with and
for Medicare Advantage plans. I thought Betsy would be the perfect person to
talk to to get a bead on what’s happening on the MA front right now.


YOU CAN LEARN MORE AT REBELLISGROUP.COM.




Betsy Seals is a cofounder and chief operating officer at Rebellis Group, a
consulting firm established to provide advisory and hands-on services to
Medicare Advantage organizations and their subcontractors. Betsy is a nationally
recognized leader in the managed care industry with over 18 years of experience.

Betsy brings to the table a solid mix of leadership and business acumen, as well
as regulatory and strategic knowledge within the Medicare landscape. Betsy’s
expertise is focused in the areas of mergers and acquisitions, compliance, sales
and marketing, strategy, supplemental benefit landscape, innovative benefit
design that addresses social determinants of health, and health plan operations.

Betsy got her start in managed care on the health plan side, where she held
roles in compliance and operations. Betsy also spent many years as a managed
care compliance and operations consultant with Gorman Health Group, where she
exited as chief consulting officer in the fall of 2018.

--------------------------------------------------------------------------------

03:45 What is a Medicare Advantage plan?
04:02 The core imperatives for leaders of Medicare Advantage plans.
04:31 “How is risk adjustment functioning?”
04:34 Making disenrollment rates and member complaints top of mind for MA
leaders.
05:40 “We all want to know why members are leaving. Well, they’re telling you!”
05:50 Star rating measures.
07:33 “Will Medicare beneficiaries really have confidence … going into the
doctor’s office … next year?”
09:11 “Now, it’s not just ‘Is your doctor in the network?’ It’s ‘Does your plan
also offer telehealth?’”
12:13 “When you really look at Medicare beneficiaries aging into the program or
… younger … beneficiaries, their shopping trends and their consumer expectations
are very much the same as yours and mine.”
13:58 CMS’s adjustment in April that allows MA plans to make changes to their
benefits midyear to provide to beneficiaries’ changing needs during the
pandemic.
16:01 Supplemental benefits as a decision-making factor in enrollees’ Medicare
Advantage plan selection.
16:28 “The decisions made during this time with how to increase benefits or how
to address the issues going on with your membership will have a really great
impact on [your] AEP [annual enrollment period].”
18:12 “I think that there’s a real lack of understanding … around what issues
are impacting their actual membership … but really understanding the
demographics and the social determinants of health that are impacting your local
landscape.”
19:30 “Health care’s not always related to in-office doctor visits.”
19:40 “I really do think that CMS is headed … to understanding that federal
dollars for the Medicare program should not just be spent on doctor’s visits or
screenings.”
21:10 “I think that there’s been a real shift in … what we understand now and
also what we’re able to predict.”
23:24 Where Medicare Advantage plans fall in addressing population health
management, working with hospital organizations, and social determinants of
health.
24:24 Betsy’s advice for providers dealing with MA plans.
24:46 “I … think that this is … a missed opportunity [for] provider and plan
partnership in a lot of ways.”
26:07 “Really understanding that the market has shifted and the way the
beneficiaries enroll this year is going to be very different than it ever has
been before.”
29:25 “One thing that shouldn’t be overlooked is that we really have an
opportunity to dig into the data.”


YOU CAN LEARN MORE AT REBELLISGROUP.COM.

--------------------------------------------------------------------------------

Check out our latest #healthcarepodcast with @betsyseals of @GroupRebellis as
she discusses #medicareadvantageplans. #healthcare #podcast #digitalhealth
#MAplans

What is a Medicare Advantage plan? @betsyseals of @GroupRebellis discusses
#medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth
#MAplans

“How is risk adjustment functioning?” @betsyseals of @GroupRebellis discusses
#medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth
#MAplans

“We all want to know why members are leaving. Well, they’re telling you!”
@betsyseals of @GroupRebellis discusses #medicareadvantageplans.
#healthcarepodcast #healthcare #podcast #digitalhealth #MAplans

“Now, it’s not just ‘Is your doctor in the network?’ It’s ‘Does your plan also
offer telehealth?’” @betsyseals of @GroupRebellis discusses
#medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth
#MAplans

“The decisions made during this time with how to increase benefits or how to
address the issues going on with your membership will have a really great impact
on [your] AEP [annual enrollment period].” @betsyseals of @GroupRebellis
discusses #medicareadvantageplans. #healthcarepodcast #healthcare #podcast
#digitalhealth #MAplans

“I really do think that CMS is headed … to understanding that federal dollars
for the Medicare program should not just be spent on doctor’s visits or
screenings.” @betsyseals of @GroupRebellis discusses #medicareadvantageplans.
#healthcarepodcast #healthcare #podcast #digitalhealth #MAplans

“I … think that this is … a missed opportunity [for] provider and plan
partnership in a lot of ways.” @betsyseals of @GroupRebellis discusses
#medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth
#MAplans





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Relentless Health Value is a weekly interview podcast hosted by Stacey Richter,
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