Skip to main content

Addressing MA planning challenges with proven benefits

October 26, 2023

Product teams and their clinical and operational partners working on 2025 Medicare Advantage (MA) benefit planning are most likely strategizing and making decisions with lower payment increases in mind. But there is a way to meet rate challenges that benefits members and MA plans alike.

In addition to lower rate increases than 2023 and recent previous years, CMS will also be asking MA plans to do more to address health inequities and social determinants of health (SDOH). To meet those goals, plans will need to do more screening, fill gaps in care and focus on preventative measures, particularly for their most vulnerable members. CMS is requiring plans to address these issues by incorporating them into HEDIS measures and Medicare star ratings.  

Nutrition benefits can benefit everyone
While CMS doesn’t specify how plans should achieve these goals of doing more to address SDOH and health equity with lower rate increases, it’s clear that a nutrition benefit can be win-win for the health plan and members. Nutrition is an efficient and cost-effective way to help address inequities and SDOH while helping members to improve their health, avoid high-cost utilization, improve medication adherence and drive satisfaction with their health care and health plan.  This helps the plan achieve important quality, cost and growth targets. MA plans are most commonly choosing home-delivered, medically tailored meals (MTMs) for their nutrition benefit, as MTMs have two decades of evidence behind them as well as a strong ROI.  Produce boxes, nutrition education and flex cards that members can use to self-pay for groceries, food boxes or meals are other options some MA plans are implementing.

As poor nutrition is the leading cause of death in the U.S., driving the development and worsening of chronic conditions including heart disease, stroke, diabetes, kidney disease and cancer, it just makes sense that providing members with nutritious food can help them need a lot less health care. With about 90 percent of our health care expenditure going to care for chronic conditions, it has never been more important to focus on benefits that are proven to improve the management of these diseases.

The convenience of fully prepared meals also offers the right support to someone who has struggled to change eating habits over time, who has mobility or dexterity issues, who lives in a rural area, food desert or food swamp, who lives alone or does not cook, or who faces the combination of a chronic condition and food insecurity. When coupled with nutrition education and ongoing access to healthy foods, fully prepared, home-delivered meals have the most evidence behind them among nutrition solutions for helping members to improve clinical measures like blood pressure, hypertension and weight and avoid flare-ups can result in hospitalizations. When coupled with nutrition education and ongoing access to healthy food, they serve as a structured first step in helping people to adopt healthy eating habits for the long-term and engage in their own self-care. 

With improved health, member retention and satisfaction and cost savings, MTMs are not just a “nice to have” in your portfolio of benefits and services; they are essential, especially in this highly competitive market. KFF recently reported that 78 percent of enrollees are in MA plans that already include a meals benefit. Most of these benefits are short-term post-discharge programs. These are highly effective at helping members to avoid readmission, with published data and case studies demonstrating an estimated 25-50 percent reduction. MA plans should next look to support high-risk and vulnerable members with longer, chronic care MTM programs, to avoid hospitalizations in the first place. Data and case studies show an estimated reduction of up to 50 percent in ED and IP stays with longer meals programs. 

What are the first steps?
If you’re thinking about adding a post-discharge or a chronic care nutrition benefit for 2025, or changing your plan’s current benefit structure, take these two steps first:  

Define the goal – Is your plan focused on improving member health outcomes, specific star measures, engagement, retention or a combination? You have options. 

  • Food as medicine is a nutrition benefit that supports members as they heal from illness and injury, while also helping prevent and manage disease. These are the post-discharge and chronic care MTM programs.
  • Food as engagement is using food as an incentive that involves members in their health, narrows care gaps, improves retention and satisfaction. These may be meal or produce deliveries for members who complete a specific action like getting a flu shot or completing an assessment, or as part of a year-end MLR spend-down program. 
  • You can also design a nutrition benefit that achieves both goals. Understanding your goal first helps frame what benefits to offer. 

Choose a pathway – Based on a plan’s model of care, there are four pathways MA plans can follow to offer nutrition benefits to members:

  • Uniform flexible — Often plans offer an HDM benefit on a limited basis to help members recover from hospital stays due to illness or injury. 
  • Special Supplemental Benefits for the Chronically Ill (SSBCI) — Filing a benefit under SSBCI allows plans to tailor benefits for members with chronic conditions and innovate under the new flexible benefit design option.
  • Value-based Insurance Design (VBID) — This model removes obstacles and makes changes to help plans better address their patients’ social needs, advance health equity and improve care coordination services. The VBID model is being extended for the 2025-2030 calendar years.
  • Clinical Programs — MTMs can be wrapped into a disease management or case management program to support members who are managing a chronic illness and have food access challenges. 

Then it’s time to forecast cost and utilization, identify your target population and start designing your plan’s nutrition benefit. 

Additional resources

And I’m here to help and answer your questions. Feel free to reach out.