C-TAC is dedicated to achieving our Moonshot goal of having more than 12M Americans living with a serious illness with a high quality of life by 2030. While the general consumer may believe that health insurance companies aren’t concerned about taking good care of their members suffering from a serious illness, health plans and other payers play a critical role in transforming and delivering high-quality care. An increasing number of health plans offer specialized programs and services for seriously ill individuals of all ages and for their caregivers to ensure the health and quality of life of this important demographic. There is a growing need for health plans and other payers to partner with providers and other members of the healthcare community to design and deliver services and benefits that care for people with a serious illness and their caregivers.
According to reports from the Department of Health and Human Services, more than 10,000 people turn 65 every day, many living with multiple chronic illnesses and in need of extra support. And many of them are choosing or are eligible for forms of coverage like Medicare Advantage (MA), commercial retiree benefits, and Medicaid. In fact, 28M people are now enrolled in MA, making up 45% of all Medicare beneficiaries. While this trend can vary by region, it is steadily increasing every year. According to a report from ASPE, MA enrollees were disproportionally lower-income, Black or Latino, and dually enrolled in Medicaid. 87.9M people are enrolled in Medicaid services, comprising 17% of the total population. This number has increased by 23% from 2020 to 2022, further demonstrating the need for coordinated and standardized approaches to caring for people of all ages with serious illnesses across all different coverage types.
Along with the increase in Medicaid and private health insurance enrollment, there has been momentum at the state and federal levels to integrate palliative care services into value-based payment environments due to its ability to achieve the Triple Aim: better care, better patient experience, and lower overall healthcare costs. Since the passage of the CHRONIC Care Act in 2018, 24% of all MA plans offer supplemental benefits for chronically ill beneficiaries, which makes up on average $2,000 in additional benefits for their enrollees. Examples of these services include non-emergency transportation services, meal delivery services, respite care services, caregiving, and palliative care services. These policy changes have made an impact on expanding services for MA beneficiaries that improve the quality of life when someone is facing a serious illness or multiple chronic conditions. Medicaid programs have also expanded their access to the same types of services. The American Rescue Plan Act (ARPA) temporarily increased federal funding to support home and community-based services for those eligible for Medicaid, with the federal government increasing their federal matching rate by 10 percentage points to enable states to develop a plan to enhance or increase the availability of these services beyond the programs that are already available. For people and families who are facing serious illness and disabling chronic conditions, this means more access to services that they previously would have had to pay for themselves.
More than ever, private payers have an opportunity to act as areas of innovation for models and services that could be offered to Medicare and Medicaid beneficiaries with serious illness. C-TAC is enhancing our advocacy for these services by facilitating discussions between health plans and other payers and leaders at the federal and state levels. In May 2022, C-TAC convened more than 60 leaders from health plans, Accountable Care Organizations (ACO), and integrated health systems with leaders from the Centers for Medicare and Medicaid Innovation (CMMI) to discuss areas of partnership to integrate palliative care services into the existing health plan and CMMI models. Discussions were focused on feedback on the Value-Based Insurance Design model currently testing the hospice benefit, lessons learned from ACO models, and the integration of palliative care models into specialty care, like the newly released Enhanced Oncology Care Model. We plan to continue working with our payer members to share feedback with federal leaders that can work to improve the implementation of these models. In addition, C-TAC is working to accelerate the dissemination of best practices and evidence coming out of these innovative organizations so that more people with serious illness have access to services aligned with our Core Principles for Care Models. In August 2022, C-TAC facilitated a virtual convening of health plans, sharing evidence on how palliative care services have demonstrated the improved patient quality of life, clinical outcomes, and fiscal outcomes for their members. This health plan working group will continue to meet on a regular basis to share information and improve C-TAC’s advocacy plan, with an in-person meeting occurring at our National Summit in October.
October’s in-person meeting at the National Summit will include participation from CMMI leadership, America’s Health Insurance Plans (AHIP), the Blue Cross Blue Shield Association (BCBSA), the Alliance of Community Health Plans (ACHP), and national experts to discuss the latest evidence in delivering palliative care services and provide feedback on what is needed to successfully implement strategies to incorporate C-TAC’s Core Principles. As part of this session, health plan participants will be able to share feedback on current models with CMMI, Medicare, and Medicaid leadership, will receive a toolkit on the best practices in implementing payer strategies to support people with serious illness, will receive the most recent data outcomes from payer palliative care programs, and will receive our updated ACT Index report that can help identify areas of opportunity to impact care for their members.
