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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\u2014and that number is only expected to grow.

So, in case you\u2019ve been out of the loop, at the beginning of 2020, CMS (Centers for Medicare & Medicaid Services) rolled out a third category of these \u201cchronic supplemental benefits.\u201d 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 \u2026 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 \u2026 corona.

So, the question I\u2019m 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\u2019d 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\u2019s 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\u2019s 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\u2019t actually reduced PMPM (per member per month) costs last time I looked at it, you\u2019d 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\u2019ll 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\u2019s happening on the MA front right now.

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\u2019s 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 \u201cHow is risk adjustment functioning?\u201d
04:34 Making disenrollment rates and member complaints top of mind for MA leaders.
05:40 \u201cWe all want to know why members are leaving. Well, they\u2019re telling you!\u201d
05:50 Star rating measures.
07:33 \u201cWill Medicare beneficiaries really have confidence \u2026 going into the doctor\u2019s office \u2026 next year?\u201d
09:11 \u201cNow, it\u2019s not just \u2018Is your doctor in the network?\u2019 It\u2019s \u2018Does your plan also offer telehealth?\u2019\u201d
12:13 \u201cWhen you really look at Medicare beneficiaries aging into the program or \u2026 younger \u2026 beneficiaries, their shopping trends and their consumer expectations are very much the same as yours and mine.\u201d
13:58 CMS\u2019s adjustment in April that allows MA plans to make changes to their benefits midyear to provide to beneficiaries\u2019 changing needs during the pandemic.
16:01 Supplemental benefits as a decision-making factor in enrollees\u2019 Medicare Advantage plan selection.
16:28 \u201cThe 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].\u201d
18:12 \u201cI think that there\u2019s a real lack of understanding \u2026 around what issues are impacting their actual membership \u2026 but really understanding the demographics and the social determinants of health that are impacting your local landscape.\u201d
19:30 \u201cHealth care\u2019s not always related to in-office doctor visits.\u201d
19:40 \u201cI really do think that CMS is headed \u2026 to understanding that federal dollars for the Medicare program should not just be spent on doctor\u2019s visits or screenings.\u201d
21:10 \u201cI think that there\u2019s been a real shift in \u2026 what we understand now and also what we\u2019re able to predict.\u201d
23:24 Where Medicare Advantage plans fall in addressing population health management, working with hospital organizations, and social determinants of health.
24:24 Betsy\u2019s advice for providers dealing with MA plans.
24:46 \u201cI \u2026 think that this is \u2026 a missed opportunity [for] provider and plan partnership in a lot of ways.\u201d
26:07 \u201cReally 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.\u201d
29:25 \u201cOne thing that shouldn\u2019t be overlooked is that we really have an opportunity to dig into the data.\u201d

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

\u201cHow is risk adjustment functioning?\u201d @betsyseals of @GroupRebellis discusses #medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth #MAplans

\u201cWe all want to know why members are leaving. Well, they\u2019re telling you!\u201d @betsyseals of @GroupRebellis discusses #medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth #MAplans

\u201cNow, it\u2019s not just \u2018Is your doctor in the network?\u2019 It\u2019s \u2018Does your plan also offer telehealth?\u2019\u201d @betsyseals of @GroupRebellis discusses #medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth #MAplans

\u201cThe 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].\u201d @betsyseals of @GroupRebellis discusses #medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth #MAplans

\u201cI really do think that CMS is headed \u2026 to understanding that federal dollars for the Medicare program should not just be spent on doctor\u2019s visits or screenings.\u201d @betsyseals of @GroupRebellis discusses #medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth #MAplans

\u201cI \u2026 think that this is \u2026 a missed opportunity [for] provider and plan partnership in a lot of ways.\u201d @betsyseals of @GroupRebellis discusses #medicareadvantageplans. #healthcarepodcast #healthcare #podcast #digitalhealth #MAplans