The Bipartisan Budget Act of 2018 allows MA plans to add a new set of flexible, supplemental benefits – not all of them primarily health related – to address care gaps and improve outcomes for chronically ill members. These benefits are called Special Supplemental Benefits for the Chronically Ill (SSBCI).
Under SSBCI, health plans can offer innovative benefits to address chronic health conditions like diabetes, heart disease, and others, as long as there is a reasonable expectation that the benefits will improve the individual’s health or well-being.
And, unlike other Medicare benefits, SSBCI can be applied “non-uniformly”, meaning the benefits don’t have to be made available to everyone in the plan.
SSBCI overview
Here’s a general overview of how SSBCI works.
Eligibility
Patients eligible for SSBCI must be chronically ill, meaning the individual:
- Has one or more life-threatening, comorbid, and medically-complex chronic conditions that limit the individual's health
- Is at high risk of hospitalization or faces other serious health outcomes
- Requires intensive care coordination
Benefits
The range of benefits health plans can offer under SSBCI is broad. The Centers for Medicare & Medicaid Services (CMS) offers the following examples as potential SSBCI benefits:
- Meal benefits - Patients with chronic illnesses such as heart disease or diabetes could receive home-delivered meals. This service not only makes it easier for patients with limited mobility to receive regular meals, but those meals can also be customized to address a chronic health condition.
- Non-medical transportation - Some members may not have easy access to transportation. Under SSBCI, health plans could offer transportation to members for non-medical reasons, such as a trip to the grocery store or bank.
- Home modifications - Homes with steps, narrow hallways, and hard-to-open doors can make living at home difficult for chronically ill members in wheelchairs. SSBCI allows health plans to offer benefits to add permanent mobility ramps or widen doorways to make a member's home livable and help them stay at home longer.
CMS lists many other supplemental options including housing, complementary therapies, and social needs benefits. Here are more details on SSBCI.https://www.cms.gov/Medicare/Health-Plans/HealthPlansGenInfo/Downloads/Supplemental_Benefits_Chronically_Ill_HPMS_042419.pdf
The 'Why' Behind SSCBI
MA plans are already complex, so why make them more complicated by adding SSBCI? Look at the data. These benefits may have a positive impact on member experience and outcomes, and make a difference in the bottom line. Using home-delivered meals as an example, here’s how a home-delivered meal program may impact members and health plans.
Reduced costs and admissions - By providing regular, medically-tailored meals to patients with chronic illnesses, health plans can improve outcomes and reduce costs. In a study published in Health Affairs of patients who were dual eligible for Medicaid and Medicare, participants who received medically-tailored home-delivered meals had fewer emergency department visits, fewer inpatient admissions, and lower medical spending than other study participants. 1
Increased member satisfaction - Many patients can’t – or won’t – cook for themselves so having meals delivered to the home makes it easy for them to get the good nutrition they need. SSBCI allows health plans to tailor benefits so patients with heart conditions can receive heart-friendly meals and diabetics can receive diabetes-friendly meals. Members appreciate the convenience and customization which can be reflected in their satisfaction scores and in increased plan enrollment.
Improved national health scores - The government uses many patient experience and outcome measurements to evaluate MA plan performance, including Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Medicare Star ratings. Offering an SSBCI benefit such as a meal plan can lead to better health outcomes and happier patients which, in turn, can lead to higher scores.
Beyond SSCBI
Some health plans are looking beyond SSBCI to other benefits that support preventive health and differentiate their MA offerings. Some plans include fitness tracking devices or provide online wellness platforms to encourage healthier lifestyles. Others offer Medicare Medical Savings Accounts (MSA) that help members save money to meet annual deductibles.
The big take away from SSBCI is that, thanks to legislation and technology, health plans have more innovative ways to improve health outcomes, lower costs, set their plans apart, and give consumers in the market for an MA plan more – and better – choices.
Mom’s Meals works with health plans, managed care organizations, and other agencies around the country to offer nutritionally tailored, home delivered meals to Medicare and Medicaid patients. Learn more.
- https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0999?journalCode=hlthaff