How to Introduce Medicare Advantage Caregiver Benefits in SNPs

March 25, 2022 - Payers cannot ignore the crucial role that caregivers play in members’ health, wellness, and recovery, and should consider supporting caregivers through Medicare Advantage caregiver benefits, especially in special needs plans.

Special needs plan members—and, by extension, their caregivers—face a particularly complex healthcare environment.

“A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals,” the CMS website explains.

The site also notes that individuals in a special needs plan can qualify for one of three reasons. Eligible beneficiaries might be institutionalized, they could be dual-eligible beneficiaries who receive both Medicare and Medicaid benefits, or they might have a severely disabling condition. 

Any of these conditions could require extensive caregiver engagement.

This population also may experience a high rate of social determinants of health barriers. Caregivers are often acutely aware of these barriers since approximately four in ten members who receive caregiving support live with their caregivers.

Health plans that recognize the importance of a strong caregiver may institute caregiver benefits to reinforce that role. 

CMS has also acknowledged the importance of such benefits, making caregiver benefits a viable Medicare Advantage supplemental benefit for contract year 2020. Since then, health insurance industry leaders have identified caregiver benefits as a prime target for digital innovation.

Scott Sarran, MD, chief medical officer at MoreCare, Abigail Sibley, associate director of clinical initiatives and product at MoreCare, and their team noticed both the challenges of caregiving and the unique barriers in special needs plans. In response, MoreCare partnered with a technology vendor, Carallel, to provide caregiver benefits.

“I have spent time working at nursing homes and I think one of the things that continues to get missed is that to truly treat someone holistically, you need to include their caregiver,” Sibley told HealthPayerIntelligence. “That's what we are striving towards is to get that caregiver included in the care planning that we do around the decisions we need to make for a member.” 

After building MoreCare’s caregiver benefits, Sarran and Sibley noted two components of caregiver support that health plans should strive to offer: educational resources and a listening ear.

Educational resources

Caregiver benefits can be a crucial channel for educating families and communities about how to support members.

Education can be critical during a transition from one site of care or treatment approach to another. Naturally, members and caregivers alike may have many questions when facing a new environment or a new phase of treatment.

For example, advanced care planning is one of the key areas in which MoreCare seeks to offer caregiver education. 

In advanced care planning, a member is informed about the kinds of healthcare decisions her future treatment might require and shares her preferences with her care provider and others engaged in the process. The member may also include her wishes for end-of-life care, if appropriate.

“It’s a way to empower our members and their families to feel like they have more control over the trajectory of care,” Sibley said.

To support caregivers through processes like advanced care planning, MoreCare pursued a multimodality approach to education.

“For the families of our members, they want to know their loved one is being well-cared for, and it’s our responsibility as the health plan to provide as many resources as possible to support that—in other words, multimodality care,” Sibley explained.

Communicating with caregivers of special needs plan members must incorporate multiple modalities because members in such plans have complicated needs, involving both social determinants of health barriers and complex conditions.

“In a population characterized by both health equity barriers on the one hand and really serious illness nearing the end of their lives on the other hand, you just have to try to meet people where they are,” said Sarran.

To accomplish this, MoreCare brought more stakeholders to the table, including a vendor that can provide digital support to caregivers on a range of needs. 

The payer’s role as an educator does not end with one task, like advanced care planning. Education is a constant throughout special needs plan member engagement. Sarran emphasized that health plans should ensure providers keep caregivers and members up-to-date on their illness trajectories.

Providers should be integrated into the multimodality framework because they have some of the most vital insights into members’ values and preferences, Sarran added. Payers cannot expect providers to carry out caregiver support independently, especially if the providers are in a fee-for-service model.

However, as with so many pilots, the balance between scaling solutions and retaining a customized approach may present challenges for a multimodal approach to caregiver support, Sarran warned.

Compassionate, bidirectional listening

Caregiver engagement must also be marked by compassionate and bidirectional listening, MoreCare experts emphasized.

The activities of caregiving—which can range from providing transportation to financial management—place a strain on caregivers’ mental and physical health. 

During the pandemic, self-reported stress among adult caregivers rose on average three percentage points over pre-pandemic levels, according to the Seniorly Resource Center. Stress was particularly high for caregivers who were only children.

Health plans should be prepared for caregiver stress to factor into their caregiver engagement. Given the emotional toll and the number of tasks that caregivers have to juggle, particularly with six in ten caregivers employed full-time, payers should be ready to repeat conversations with caregivers and engage in bidirectional listening amidst caregivers’ mental healthcare needs.

In advanced planning, for example, a caregiver will work with their member and the health plan to consider who the member is, what he wants, what his values are, and how to integrate these preferences and beliefs into his plans for the future. This can be an emotionally taxing process. Simultaneously, the caregiver may be grieving the impending loss of the loved one.

While imparting information in a digestible way through caregiver education is important, it is also critical for health plans to listen to caregivers and their needs.

To Sarran, the need for compassionate, bidirectional listening also underscores the value of multimodality in caregiving benefits. Caregivers may require various channels through which to communicate their loved ones’ preferences and identities in addition to sharing what caregivers and members need from their health plans. 

Taking a multimodal approach to caregiver listening enables health plans to achieve a more holistic view of their members.

To facilitate better communication with caregivers, MoreCare found a vendor partner that uses a digital platform, offering space for the long and complex conversations that caregivers may need to have.

“Caregivers and caregiver needs are highly variable, so it is important that we combine access to expertise that is flexible and responsive to both user preference and the topic raised,” Sibley said of the tool. “That can be everything from providing DIY web-based resources to direct conversations and coaching sessions.”

Sibley and Sarran are not alone in promoting digital supports for caregivers.

In a New England Journal of Medicine study that investigated the business case for offering family and caregiver supports in Medicare Advantage programs, researchers found fiscal advantages to offering three types of caregiver benefits: virtual assistants, peer support groups, and strategies that integrate caregiver and member workflows.

Virtual assistants for seniors who require chronic disease management for multiple chronic conditions cost $3 per member and saved the study’s Medicare Advantage plan nearly $500 per patient annually. These virtual assistants would be directly helping members while indirectly reducing the burden on caregivers.

Integrated workflows for caregivers and members with dementia or cognitive disabilities could save almost $3,170 per member per year.

Peer support groups for caregivers could produce net savings of $861 per caregiver each year. Plus, the financial savings extended to members, reducing member healthcare spending by over $1,460 member per year.

Both the potential for savings and the national trend of eroding caregiver mental health may promote offering a mix of digital and personal payer solutions for caregivers.

Measuring the success of caregiver benefits

One of the primary ways to gauge the success of caregiver benefits, particularly for a newer program, is measuring member and caregiver satisfaction.

During the early stages of a caregiver’s involvement with a caregiver benefit, the quality measurement survey does not have to be complex. 

Sibley recommended implementing a survey after educational materials. For example, a health plan might offer the opportunity for feedback following an advanced care planning presentation. MoreCare asks questions such as “was this helpful?” and “would you recommend this?”

“What is most important is member and family satisfaction with that benefit,” Sibley explained. “Do they feel heard? Do they feel like it was helpful to participate in that conversation, whether it was compassionate listening or whether it was guiding questions around advanced care planning? At a very basic level: did it help?”

As payers hone their Medicare Advantage special needs plan caregiver benefits, the questions may evolve. For now, providing multimodality educational resources and bidirectional listening is a key step toward understanding both the caregiver and the member holistically.