Why are MA Plans Expanding SSBCI Offerings and What’s the Best Approach?

Medicare Advantage plans have a unique opportunity to help chronically ill members through offering or expanding Special Supplemental Benefits. We provide an overview of SSBA trends and the type of benefits offered, as well as how you can implement the most appropriate benefits through a Design + Lean Thinking approach.

Medicare Advantage SSBCI Overview & Trends

CMS Expands Medicare Advantage Benefits through SSBCI: primarily health-related and non-medical

The CHRONIC Care Act of 2018 gave Medicare Advantage plans new flexibility to offer Special Supplemental Benefits for the Chronically Ill (SSBCI) that are intended to help enrollees with specific chronic conditions. In 2019, MA plans could offer a wider array of primarily health-related benefits. And, in 2020, plans could begin offering Special Supplemental Benefits for the Chronically Ill (SSBCI), including a host of non-medical services.

Examples of Non-Primarily Health Related Special Supplemental Benefits for Chronically Ill Members

  • Meals (beyond limited basis)
  • Food and Produce
  • Transportation for Non-Medical Needs
  • Pest Control
  • Indoor Air Quality Equipment and Services
  • Social Needs Benefits
  • Complementary Therapies (licensed or certified)
  • Services Supporting Self-Direction (e.g., power of attorney for health services, financial literacy classes, technology education, and language classes)
  • Interpreter Services (e.g. to facilitate encounters with healthcare providers)
  • Structural Home Modifications
  • General Supports for Living
  • Service Dog Support

Top 2020 SSBCI Benefit Offerings by Medicare Advantage Plans

  • 49% offered Pest Control
  • 41% offered Food and Produce
  • 35% offered Transportation for Non-Medical Needs
  • 30% offered Meals (Beyond Limited Basis)
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SSBCI Adoption Rates Increasing

In its first year, SSBCI was relatively limited with only six percent of MA plans offering these benefits. In 2020, 11 percent of MA plans offered SSBCI and supplemental benefit availability varied substantially by condition. And, while a limited number of plans targeted their benefit designs to better meet the needs of beneficiaries with certain chronic illnesses, initial analysis of 2021 SSBCI offerings indicate steady growth — 16 percent of non-employer MA plans are offering SSBCI in 2021 versus six percent in 2020.

CMS aimed to encourage plans to broaden their offerings and consider how they could use supplemental benefits to better address enrollees’ needs. As a result, the number of plans offering certain nonmedical benefits — including meals, transportation, in-home support services, and acupuncture — doubled between 2018 and 2020.

Plans offering primarily health-related supplemental benefits increased substantially between 2018 and 2020:

  • Meal benefit grew by (20% of plans to 46%)
  • Transportation benefit grew by (19% to 35%)
  • In-home support services grew by (8% to 16%)
  • Acupuncture grew by (11% to 20%)

Which Medicare Advantage Plans are Offering SSBCI?

According to research in JAMA, “Health maintenance organizations, older plans, and plans with higher ratings more frequently offered new benefits. Older plans may have an established infrastructure that allows for the early adoption of new services. Plans rated four stars or higher receive bonuses from the Centers for Medicare & Medicaid Services (CMS) in the form of rebates, which may be used to invest in new services for enrollees.”

In 2020, new MA products, that included expanded SSBCI, were offered in highly competitive markets, including Southern California, Ohio, Pennsylvania, and Texas. Going forward, MA plans in underpenetrated markets could utilize supplemental benefit offerings to differentiate.

Expanding Supplemental Benefits Using Design + Lean Thinking

While SSBCI offerings are expanding, there is still a relatively small percentage of plans participating and an even smaller percentage who are adequately addressing the population with two or more chronic diseases. Some research suggests that more plans would offer SSBCI, including non-medical benefits, if they could overcome the operational and logistical challenges, as well as having a better understanding of which benefits are needed by their chronically ill members and which would differentiate in the marketplace.

At SDLC Partners, we believe that a blended Design + Lean Thinking approach is the route to determining which benefits could best support member quality of life and outcomes from the perspective of your high self-advocating members and low self-advocating members. Utilizing quality measures and data analytics like segmentation will help payers better understand how their members try to solve these issues on their own, revealing which investments could drive the best outcomes and experience for current and prospective members.

Call SDLC Partners Before You Add or Adjust SSBCI Offerings

Before you decide on which benefits to add or expand, call us. We will use our Design + Lean Thinking approach to reveal which benefits could yield the best outcomes and are in the greatest demand by your current and prospective members. Protect and maximize your investment.

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