Incorporating modern technology benefits into Medicare Advantage plans

With the explosion of COVID-19, Medicare Advantage (MA) plans began to broadly adopt telemedicine benefits for the first time in 2020. The Center for Medicare and Medicaid Services (CMS) approved the use of telemedicine for the treatment of COVID-19 in March, then expanded the benefit permanently soon thereafter. Most recently, CMS introduced the Acute Hospital Care at Home program, which allows for daily patient monitoring by treating acute care patients from home.

In addition to telemedicine, CMS added 135 additional services to MA plans in 2020, including inpatient and nursing facility visits, discharge day management services and visits to the emergency room. Although these benefits are valuable, technology and at-home care benefits can’t be overlooked during a global health crisis. As higher-risk patients need to find virtual ways to access their providers, MA plans must cover telemedicine, telehealth, and other at-home care solutions.

Telehealth should no longer be optional

Telehealth is bridging the care gap for both high-acuity patients and patients who would otherwise avoid their healthcare visits. When patients can quickly access their health records, providers or care teams from home, clinics are more equipped to monitor patient’s symptoms that could be of concern. This proactive care can also help to unveil larger, underlying conditions that can threaten patient health.

Telemedicine also tends to be more cost-effective for payers. Even though the cost of virtual care is similar to the cost of in-person care for most MA members, it helps reduce overall healthcare expenses by eliminating unnecessary hospital visits. When concerned patients can virtually connect with their providers safely from home, their providers can tell them whether they need to visit the Emergency Department or if non-emergent treatments are sufficient.

Additionally, The U.S. Department of Health Services reported that nearly half of all Medicare primary care visits were through telemedicine in April alone; this form of care isn’t going to subside in popularity once the COVID-19 crisis eases. As Medicare-eligible seniors become more technologically literate, virtual care will continue to grow in popularity and importance.

The case for Remote Patient Monitoring

Telemedicine coverage through most MA plans is rising substantially, but Remote Patient Monitoring (RPM) should be equally prioritized. Fortunately, CMS just took a major step in the promotion of RPM. On December 1, 2020, CMS finalized its RPM regulations for 2021, which includes guidelines on medical devices for remote monitoring, a revised definition of direct supervision during COVID-19, and clarification on its payment policies.

RPM is critical for high risk patients. Although MA plans are covering RPM and the majority of plan providers are waiving patient responsibility, most MA plans aren’t providing the devices such as glucometers, pulse-oximeters, blood pressure cuffs, wearable devices, and corresponding web-based solutions. Although that could change in the upcoming years, patients in need of consistent care should have access to remote monitoring.

Making technology accessible for everyone

As virtual care continues to gain traction, MA providers need to have a plan to ensure members can access their health services without issue. This can include sending step-by-step instructions on how to enter their virtual appointment, providing a cellular hotspot to transmit data without patient interaction, or by having a team of care navigators who are qualified to assist.

Care navigators can be a critical component for patients who need help understanding the complexities of the healthcare system. Navigators are a great resource to assist with tasks like arranging transportation to in-person appointments, helping patients refill their prescriptions or organizing drug delivery services. They serve as advocates throughout a patient’s healthcare journey and significantly improve accessibility for patients who might otherwise struggle to connect to their healthcare providers.

Technology is now at the disposal of the healthcare community to elevate patient care, improve health outcomes, and increase access to quality medical services. For this reason, telehealth and telemedicine will continue to grow in importance as access and ease-of-use for medical technology increases. Proactive virtual care is easing the clinical care burden of in-person, Emergency Department reactive care. This level of simplicity is paramount, especially during the COVID-19 pandemic.

About the Author

Dr. Kishlay Anand is a board-certified cardiologist and electrophysiologist and Akos CEO and co-founder. Dr. Anand garnered extensive administrative experience serving as Chairman of InstantMed Health Center, an innovative healthcare delivery model with Urgent Care and Primary Care Centers in the Phoenix metropolitan area providing lab, radiology, and diagnostics—all at one convenient location.

Four Things to Consider When Reviewing Medicare Advantage Open Enrollment Period

Four Things to Consider When Reviewing Medicare Advantage Open Enrollment Period (OEP)

The Medicare Advantage open enrollment period, or MA OEP, is a Medicare enrollment period that runs from January 1 through March 31 each year. The MA OEP gives beneficiaries who are enrolled in a Medicare Advantage plan a chance to change their coverage. Changes are effective the first of the following month.

Unlike the annual enrollment period, or AEP, the MA OEP is only available to some Medicare beneficiaries.  As the Open Enrollment Period kicks off on January 1, consider these four things before committing to a plan:

Cost

While specific plans can differ widely, it’s typically more cost-effective to receive benefits from Medicare Advantage instead of Original Medicare because out-of-pocket costs tend to be lower. According to Medicare.gov, many Medicare Advantage plans have a $0 monthly premium. In some cases, out-of-pocket costs are even included.

With Original Medicare, there’s no limit to your potential medical bills. If you have a chronic health condition or an unexpected health crisis, you could pay thousands. Most Medicare Advantage plans can now also cover benefits than they haven’t in the past, like vision, hearing dental and more– some that Original Medicare doesn’t cover.

Telemedicine Benefits

New for 2021, there are several value-added benefits included in most Medicare Advantage plans, most notably telemedicine. With the onset of COVID-19, telemedicine has bridged the care gap for at-risk seniors.

The Centers for Medicare & Medicaid Services (CMS) approved telehealth benefits in 2020, and the technology has exploded in popularity since. The U.S. Department of Health Services reported that nearly half of all Medicare primary care visits were through telemedicine in April alone, and this form of care isn’t going to subside in popularity once the COVID-19 crisis eases. As Medicare-eligible seniors become increasingly technologically literate, virtual care will continue to grow in importance.

“As telemedicine becomes more widely available, people looking to choose a Medicare Advantage plan should consider how different plan options approach virtual service delivery,” said Dr. Kishlay Anand, Arizona cardiologist and CEO of Apricus Health. “Ease-of-use is absolutely paramount, especially for those who struggle with technology. I recommend carefully reviewing Medicare Advantage plans that not only include telemedicine, but also allow users to connect virtually with as little complexity as possible.”

Accessibility

To get the most from a Medicare Advantage plan, it’s critical to understand how user-friendly a plan’s technology benefits are, in addition to how robust its patient support network is. Care navigators are an excellent point of communication between members and providers, and plans that include personal care navigators greatly improve accessibility. They do this by helping with appointment scheduling, drug delivery and technology, and by answering member questions.

“I encourage Medicare-eligible patients to seek plans that are easy to understand,” said Dr. Greg Celaya, a family practice physician in Arizona that is part of the Apricus Health Network. “Medicare Advantage plans should be as straightforward and simple as possible, so consider how the plan aims to provide tangible value to its members. Care navigators and customer support can play an integral role in the patient experience by aiding with all aspects of the healthcare process.”

Accessibility also extends to technologies like telehealth and more. If healthcare technology requires multiple software downloads and a newer operating system to use properly, then it’s likely going to cause more trouble than it should. Setting up telemedicine appointments, reviewing personal health data and speaking with a provider should only require the click of a single link and not one step more.

Plans that include care navigators are a rare find, but they can mean the difference between spending endless hours on the phone with multiple organizations. Care navigators should also be available to help members download the necessary systems to their personal computer, so when it’s time for a virtual appointment, members can simply click on a link to speak with their provider. When it comes to Medicare Advantage benefits, simplicity and personal service is everything.

The Future of Care

Those eligible for Medicare Advantage should also consider how adaptable a plan is to changing times. Medicare benefits tend to improve year-over-year, as seniors continue to evaluate ancillary benefits.

Something up-and-coming worth noting is the increased use of Remote Patient Monitoring (RPM). RPM is the use of technology to keep up with a patient outside of a clinical setting, which helps to further increase care access. Although most Medicare Advantage plans will cover RPM reimbursement, most plans don’t include the devices needed to execute this. These devices include blood pressure cuffs, pulse oximeters, blood sugar monitors and more.

“For higher-risk patients that need constant, connected care, choosing a Medicare Advantage plan that covers the use of remote patient monitoring devices is essential,” said Arizona Apricus Health Network physician Dr. Merle Turner. “As a healthcare provider, it’s key for me to know what’s going on with my patients, especially those who can’t be seen regularly in person. Having a plan that addresses at-home monitoring without any burden on the patients is a win for doctors and members alike.”

The Apricus Way

To provide access to convenient, and affordable healthcare throughout the Phoenix metropolitan area, Apricus Health was designed by local healthcare experts to improve patient outcomes. Our friendly, knowledgeable care navigators are ready to assist you 24 hours a day, committed to delivering “Care Your Way.” Apricus has established a growing health network comprised of Arizona’s leading primary care and specialty healthcare providers, 24/7 Urgent Care Centers, Med Clinics and simple-to-use telehealth solutions.

With the right Medicare Advantage plan, you can receive all the Apricus Health member benefits at no additional cost, including:

  • A dedicated Care Navigator to help schedule appointments, refill prescriptions, arrange telehealth visits and navigate today’s complex healthcare system
  • Access to over a dozen popular prescriptions at no charge and reduced costs on other prescriptions
  • Free same-day home prescription delivery
  • 24/7 access to telehealth providers who have the patient’s current medical records
  • Proactive, around-the-clock Home Monitoring for members with chronic diseases

For more information about Apricus or to speak with a State-Licensed enrollment expert, please visit our Medicare Advantage resource page or call 602-357-CARE (2273).