As we are in the second month of the long-awaited new year, COVID-19 remains top of mind. The extent of the pandemic’s damage to patients‘ health and patient data remains to be seen, but it affects every industry tier. The Medicare Advantage (MA) market is no exception.
Not only has the pandemic overwhelmed hospital systems and created a number of financial unknowns over the last year, but it has significantly driven down utilization while the costs associated with COVID-19 treatment have risen. On January 15th, the Centers for Medicare and Medicaid Services (CMS) released the 2022 rates for MA and Part D members early. This final rule’s announcement acknowledged that COVID-19 would continue to play a major role in 2021 and how we approach healthcare moving forward.
The pandemic has undoubtedly disrupted the MA population, and the new presidential administration will affect imminent policies. With a wide utilization gap, social determinants of health (SDOH), and growing behavioral health needs, it is vital to identify where we need to intervene the most.
What to Expect with a New Administration
On January 21st, the National Association of ACOs (NAACOS) gave the webinar “2021 Federal Policy Outlook for ACOs.” The new presidential administration considers the pandemic and vaccine distribution its most pressing business matters. In response, the industry should brace for potential regulatory freezes, executive orders, and other CMS policy change memos related to the pandemic.
We saw this quite often at the beginning of 2020, and as we see through the vaccine distribution and different approaches of addressing the pandemic, MA organizations may have more to navigate. Additionally, industry experts speculate that the new administration may consider new policies to lower the Medicare eligibility age to 60, resulting in approximately 18 million new beneficiaries.
One of the most notable effects of the pandemic can be seen in claims utilization analysis, which indicates that many enrollees have foregone routine treatment for acute and chronic conditions. In my last webinar presentation, I discussed that we know and expect that risk adjustment factor (RAF) scores will be down with missed care opportunities, particularly in primary care settings.
Specifically, in a white paper by Milliman, the authors predict a 1 to 9% total reduction in risk scores. Milliman‘s study also revealed that deferred care, especially chronic conditions and pent-up demand for services, will increase healthcare costs post–pandemic.
Fear was a major player in patients receiving their routine care throughout COVID-19. Since it is the beginning of the year, many MA organizations are focused on Annual Wellness Visit (AWV) campaigns. But, we still see resistance from patients regarding coming into the office for appointments. Undoubtedly, this hesitation will impact any primary care providers’ ability to accurately code hierarchical condition category (HCC) codes and many quality care gaps.
Social Determinants of Health and Behavioral Health
As we begin to formulate member outreach plans to catch up and tackle the care deficit left by COVID, it is helpful to understand precisely where and how the Medicare population is struggling. We already know that the Medicare population faces unique challenges with SDOH.
We can expect to see new challenges of the pandemic compound these issues related to access to care and other social determinants. In the CMS report “COVID-19 Experiences Among the Medicare Population,“ one of the most reported daily life struggles was that 12% of beneficiaries could not get basic household supplies.
Over the past year, we have seen rapid changes to telehealth policies. As we approach the hopeful end of the imminent COVID-related challenges, telehealth will continue to be a powerful tool to reach patients with mobility or transportation hindrances.
We should expect to see the prevalence of depression and other mental health-related diagnoses increase, and hopefully, telehealth will become a powerful tool to address them. Organizations will want to make sure they screen for depression, anxiety, and other mental health conditions in their visits with patients. It is known that depression has repercussions that can impact health outcomes.
Cindy Dyer is a Product Manager at Lightbeam.