Medicare Advantage Vendors Brace for Supplemental Benefits Cuts

Modern Healthcare | By Lauren Berryman
 
Companies that have profited from the largesse of Medicare Advantage insurers seeking to lure customers with generous perks are looking ahead to a tough 2025.
 
Humana and CVS Health subsidiary Aetna are among those signaling that curtailing supplemental benefits such as transportation, fitness memberships, in-home support services, and vision, dental and hearing coverage will be a key part of their strategies to restore margins in a business troubled by high costs and a more restrictive regulatory environment.
 
Related: What insurers got wrong about Medicare Advantage costs
 
Take Modivcare, which provides remote patient monitoring and non-emergency medical transportation for Medicare Advantage members. The publicly traded company, which also contracts with states and Medicaid insurers, relies on Medicare Advantage for about one-fifth of its revenue, said Seth Ravine, chief commercial officer. But that could change next year as insurers reevaluate supplemental benefits.
 
“The reality for the MA plans is they can't do everything for everyone with fixed financial constraints or on a fixed budget,” Ravine said.
 
If the company's insurer clients pull back from covering transportation, that would leave patients who can't get to their medical appointments in the lurch, he said.
 
Aetna and Humana confirmed on their most recent earnings calls that they’ve taken actions to trim benefits next year. UnitedHealth Group and Elevance Health told investors that financial challenges have them scrutinizing which benefits that go beyond fee-for-service Medicare will remain next year.
 
“Those are putting a lot of financial pressure on plans’ margins and, as such, they just don't have as much money to invest in supplemental benefits in their bids this year as they have had in the past,” said Alexis Levy, senior partner at HealthScape Advisors, which is part of the Chartis Group, a consulting company.
 
That spells bad news for companies on the receiving end of the supplemental benefits boom, Levy said. “It could definitely be a financial headwind for vendors if they're starting to see some of their customers cut back,” she said.
 
Medicare Advantage insurers have had a challenging 18 months, leading some to misforecast expenses and overpromise to investors. Higher medical costs and utilization, changes to the Star Ratings program and risk-adjustment programs, and a small rate cut for 2025 have pushed the major for-profit carriers to take hard looks at their offerings and geographic footprints…

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Caregivers Carry The Burden

By Barbara Karnes

Taking care of someone as they approach the end of their life is hard, scary, frustrating, sad, and often guilt-ridden work. Caregivers carry the burden of care but are often invisible.

We tend to give our attention to the patient by focusing on their wants, needs and changes. We come, often bringing gifts and food, and we sit with the patient. We talk, tell stories, try to laugh, then we say goodbye and leave. 

Meanwhile, the caregiver is behind the scenes doing all the work, receiving no attention, receiving no acknowledgment.

My hope in writing this blog is to draw our attention to the “unsung heroes” caring for their special person as end of life approaches, as well as to those caring for family and significant others who are not dying but in need of care. These people do the physical work while carrying the emotional burden of caring for someone they know and have a relationship (positive or negative) with.

Caregiving is 24/7 work. The nights are usually the hardest. The dark, quiet, alone time is when it seems the “goblins” of fear, exhaustion, and general tiredness come out. 

Family caregivers are untrained in physical care giving, let alone in end of life care. Think of the fear they carry knowing their special person is dying, will die, and that they are responsible for providing comfort and meeting the physical needs.

Enter hospice and end of life doulas. Their focus is as much about the caregiver as it is the patient. Now the caregiver is not alone, is not as unsure, has knowledge, support, and attention.

I suggest in addition to end of life guidance and support offered by professional end of life workers, the caregiver finds a friend who can be their support person. A friend they can call to cry or yell with. A friend who we can say “I’m scared. I’m tired. I’m mad. I’m frustrated” with. A friend that won’t have answers or even necessarily words, but who will listen.

Those of you who are caregivers know that love is a verb as well as a noun. It is an action word. It can be expressed in doing. By giving your time, your attention, and your energy you are LOVING the person you are caring for. Through the frustration, the tiredness, and the aloneness you are actively loving. What a beautiful gift you are giving.

Family Caregivers Need Further Support, New Data Shows

Home Health Care News | By Andrew Donlan
 
The U.S. Centers for Disease Control and Prevention (CDC) recently released new data on the health and needs of caregivers around the country.
 
Specifically, the study took into account the status of family caregivers, and how that changed from 2015–2016 to 2021–2022. One in five adult Americans provides care support to a friend or family member, according to the CDC.
 
The CDC recognizes this sect of the population as critically important, given that the loved ones they care for may otherwise be in a brick-and-mortar care facility. Like home care providers, these family caregivers allow seniors to age in what is oftentimes the preferable setting – the home.
 
Over that stretch of time – from 2015-2016 to 2021-2022 – the percentage of caregivers aged 60 years and older increased from 28% to 35.4%, which outpaced the general population.
 
The prevalence of frequent mental distress also increased during that time period by 2.3%. In general, caregivers are more susceptible to mental distress and depression than their non-caregiver counterparts.
 
Out of 19 health indicators, 13 were more unfavorable for caregivers than non-caregivers. Obesity, asthma, chronic obstructive pulmonary disease and arthritis especially hinders caregivers. Caregivers were also more likely to report “inability to see a doctor due to cost during both periods.”
 
But four measures did improve in 2021-2022, including the prevalence of current smoking, physical inactivity, no health coverage and inability to see a doctor due to cost.
 
These caregivers, in some cases, are likely candidates for support under self-directed programs. The Biden Administration has attempted to better support this group of individuals over the last few years.
 
“The National Strategy to Support Family Caregivers has raised awareness of the need to support the health of caregivers nationwide,” the study authors wrote. “Goals outlined in the strategy include strengthening services and supports for family caregivers and expanding data, research, and evidence-based practices. Providing relief from caregiving tasks, broadly known as “respite care,” was identified as a priority. Availability of such services can be optimized through public policies and community collaboration, resulting in high-quality, affordable and flexible care. Additional strategies to ensure financial and workplace security for caregivers have been implemented in some states and include enhancement of paid family leave and antidiscrimination laws.”

No Link Between Cellphone Use, Brain Cancer, Major Report Finds 

Medscape | By Robin Foster

In news that should reassure folks glued to their cellphones all day, a new international review finds no link between cellphone use and brain cancer.

Commissioned by the World Health Organization (WHO), the review included 11 experts from 10 countries who sifted through decades of research—5,000 studies published between 1994 and 2022 to be exact. The final analysis was published in the journal Environmental International.

What exactly were they looking for? They were trying to determine whether greater exposure to radio frequencies commonly used by wireless electronics, including cellphones, might up the chances of a brain cancer diagnosis.

What did they find? In the 63 studies they honed in on, the risk of brain cancer did not increase, even with prolonged cellphone use (defined as 10 years or more), among those who spent a lot of time on their cellphones, or for people who made a lot of calls. They also saw no increased risks of leukemia or brain cancer in children exposed to radio or TV transmitters or cellphone towers.

"These results are very reassuring," lead study author Ken Karipidis told reporters, according to the Washington Post. While cellphone use has "skyrocketed, there has been no rise in the incidence of brain cancers," he noted.

Concerns about a potential link first emerged in 2011 when the International Agency for Research on Cancer, the WHO's cancer agency, classified radio wave exposure as a possible carcinogen to humans, the Post reported, but that was based on limited evidence from observational studies.

Karipidis explained that since then, a "lot more studies have come out" on radio waves and they've been "quite extensive," prompting the WHO to commission the latest review.

Karipidis said the problem with some of the early research was that it relied on case-control studies that compared the responses of people with brain cancer against those without the disease—which can be "somewhat biased."

Not only that, but newer generation cellphone networks, including 3G and 4G networks, actually produce "substantially lower" radio frequency emissions than older networks, review co-author Mark Elwood, an honorary professor of cancer epidemiology at the University of Auckland in New Zealand, told the Post.

"There are no major studies yet of 5G networks, but there are studies of radar, which has similar high frequencies; these do not show an increased risk," he added…

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