2025: Supplemental Benefits Take Front Seat for Medicare Advantage Plans

Speaker A: Foreign.

Speaker B: And and welcome. Thank you Matter for hosting this timely discussion on supplemental benefits. Um, we want this to be interactive so please drop a question in the Q and A at any time and we're going to go ahead and get started with our, with our program here. So we're very fortunate to have three experts in this area. Uh and we're going to go ahead and have them introduce themselves starting with Dr. Amy Schiffman.

Speaker A: Thanks Mater, John and Daron for having me. Um, so I'm Dr. Amy Schiffman. I am a board certified emergency physician turned house call provider. Um, I have a ah background in uh the social determinants of health as the house calls um was a real eye opener for people who are taking care of uh those in the home. It's a very complex place to take care of people. That exploration of SDOH led me to be the chief medical officer of uh a large human services organization in the D.C. metro area. Uh with some background in care management, hospice, private duty, long uh term care and post acute care. Um since uh leaving that position I now advise um startups in go to market uh in the Medicare space particularly in populations uh who have chronic illness as well as um uh those who have um homeboundedness and end of life needs. Thanks for having me.

Speaker C: Hi, um, thank you John and thank you Matte for inviting me to participate in this important discussion. My name is Duran Porat. I'm the CEO and co founder of Active Aging. For the last uh three decades I've been um involved in many projects related to digital innovation as well as the AI based solution. I worked in both global tech giants like Samsung and GE Digital and as well as small nimble startups with cutting edge technologies. My venture into the health tech and specifically htech uh started 10 years ago actually when I was at Samsung and uh, I was leading the ah development of an AI based um remote monitoring platform for seniors. Today I'm more focused on using the latest uh AI technologies in order to improve member engagement, uh improves benefit utilization as well as overall health plan performance. Thank you.

Speaker B: Thanks Jerome and everybody. I'm John Achukin, I'll be the moderator today. I have about 20 years experience in both the provider and payer space. Have done a lot of work in uh Medicare Advantage star ratings, risk adjustment, quality improvement uh and done some work in um, in care transition management and and post acute care. Uh so we're going to jump to Amy. Um, so Amy, you know last time I worked I, I was you know deep into supplemental Benefits was about 10 years ago and it was very focused on wellness and prevention. But a lot has happened over the past seven years. Um, can you kind of share us through the evolution of supplemental benefits and why we find ourselves at this critical inflection point?

Speaker A: Sure. I appreciate the opportunity. I think level setting is always important for, um, things like this. So there's certainly been a crescendo effect, um, in the past many years of what is a supplemental benefit. So just from a level setting perspective, um, we obviously are on this call for a reason. Medicare has original traditional Medicare and Medicare Advantage early. Original traditional Medicare does not really have supplemental benefits. The supplemental benefits are primarily focused in the Medicare Advantage space. Um, these are benefits over and above what original Medicare offers. So that's just the basic definition. It's things that are offered over and above what original Medicare offers. And as far as the supplemental benefit designs, um, these are complex, right? Like it's a complicated idea here that you're going to suddenly be offering things over and above. But the supplemental benefits are in general designed to have a, uh, influence on enrollment choices for people, uh, to provide, uh, enticement benefits for people to also support the patient, the member, the provider. Um, and basically the idea is that the savings and rebates are able, that Medicare Advantage gets, are able to then finance these supplemental benefits that are again, over and above what original Medicare offers. Next slide. Um, the case for supplemental benefits can really be traced back to numerous different stakeholders. Um, everybody in the Medicare Advantage space has a place in the importance of supplemental benefits. So the health plan, the providers themselves, the people, you know, boots on the ground providing care, the members themselves, cms, as well as the community in which the supplemental benefits may be offered. Because some of them are SDOH focused and have an impact on the community at large. So supplemental benefits are generally intended to reduce out of pocket costs for members for things that they might need for their health and wellness. Um, it's to assist members, um, with issues regarding sdoh and we'll get a little bit more into those types of benefits. Um, again focusing on wellness and prevention. Um, the big gorilla in the room is often the hospital admissions and readmissions. We want to lower the costs of health care across the board. And certainly Medicare Advantage companies have that front, um, of mind. Um, and then the issue of supplemental benefits that has been part of this new crescendo are new CMS objectives and the quality measures that surround them. Um, we'll get into that a little bit more in a few minutes. But the GAO has really um, put a spotlight on supplemental benefits recently and that's why one of the reasons that we're sitting here today, um, next slide, John. So let's kind of go through briefly, um, the different types of supplemental benefit types. The general, to the far left, vision, hearing and dental. Those are often referred to as the table stakes benefits which are. This is what it takes to provide any supplemental benefits within the Medicare Advantage space. You're going to see these across the board. This is sort of required in some sort of underlying way. These are benefits that are not offered by original Medicare. This is part of the Advantage in Medicare Advantage. Uh, over time there has been an increase in the types of supplemental benefits that have been offered. The EPHRB expanded primarily health related Medicare Advantage supplemental benefits includes things that are directly related to people's health, um, starting in around 2019 and we're going to look at a timeline in just a second. These became far more, um, prevalent in the marketplace. Things like gym memberships, um, uh, standalone memory fitness benefits, um, transportation, certain safety devices in people's homes, things that can be traced back to actual health benefits. This is that bucket. And this is available to all people in any Medicare Advantage plan. So it's sort of an across the board. If you're, if you have an MA plan, you're going to be offering these across the board to your members. Then moving forward came the ssbci, which is the special supplemental benefits for the chronically ill. These are primarily focused in the SDOH space. They are in addition to the regular supplemental benefits that we just referred to, but could include things like pest control if there are issues with dust mites that might reduce asthma. Not all of them are exactly health benefits, health supplemental benefits, but can be traced back to a chronic illness. So structural home modifications, um, certain types of complementary therapies. Uh, again these can sometimes look like non actual medical and health benefits, but actually the SDOH implications of them and the social determinants of health implications of them will keep people out of the emergency room, keep them healthier and keep them well. Um, that is the goal for the ssbci and they can be tailored to the actual patient. This is more on a personalized basis per member, um, than the EPHRB benefits. So here's a timeline and again this is really meant to trigger, um, the crescendo effect of expanded attention to supplemental benefits. Um, I think I want to focus your attention on the right side of this timeline. Even though starting in 2018 and 2019 there were changes made, um, through CMS permitting certain types of supplemental benefits back in 2019 for, for certain types of non medical um services if they were used to diagnose, prevent or treat an illness or injury. Um in 2020 was the SSBCI which we were referring to. Um, more importantly is the new rules that are coming down the pike. Um primarily triggered by a GAO report that said that it's really hard for them for CMS to know which supplemental benefits people are receiving. Uh, the data is not there. In data that's being submitted by MA plans. The GAO report references that Medicare Advantage, um, Medicare Advantage companies were not familiar enough with how to report things like produce or uh, different benefits that didn't have a code. So there's been a lot of attention since that GAO report on how to figure out what beneficiaries are actually utilizing and then to notify people when whether or not they are receiving all the benefits that the MA plan has put out. Next slide. So a little bit more detail about um, the major policy changes. Um uh on the slide you see a bunch of little teeny tiny words with a big giant red circle around it. That is from the Federal Register. Um, I always encourage anyone uh, that I'm working with to go straight to the Federal Register if they really want to understand the rules and laws. Um, you know the, the uh. There's a lot of uh, reports that sort of report out from the Federal Register but always go to the Federal Register itself. Um so within the Federal Register you will find two new um, two new rules that are coming down the pike. Number one um, from the SSBCI perspective um plans must provide evidence um, that benefits are designed to actually improve or maintain the health of chronically ill um enrollees. That there should be a personalized uh, referenced uh understood reality to why a certain benefit is being offered to certain groups of chronically ill people. It does not make sense obviously to offer silver sneakers to homebound people. So there is sort of this idea that there needs to be um, a matching of the benefits with the actual needs of the members and that there should be support overall uh, for the functional well being of sustained quality of life. That means that some of these plan. This is what the SSBCI was intended to do was to provide non medical benefits potentially that could actually improve the well being of the members. So that's one, that's one thing that's coming down the pike the second year. The second thing that's coming down the pike, which I think is um, even more I um think uh administratively burdensome um to The MA plans may include this mid year benefit reminders. So imagine if in the beginning of the year you've got a bunch of new folks coming on, you're offering them all these benefits. By the middle of the year, you're going to need to let them know which benefits they have not taken advantage of. In order to do that, you kind of also need to know which benefits they are taking advantage of. Um, so there will be a quandary that we will talk about a little bit later. Daron's going to get into that. But the idea here is that these rules are going to ensure that members are fully aware of the available benefits so that they are maximizing the uh, utilization and getting what um, has been offered to them, um, at the time that they enrolled. Next slide. Digital member engagement. There's a real conversation that I think we need to have after understanding, like how do you take this enormous new, um, burden and sort of create a scenario where an MA program who may not have been keeping track of which supplemental benefits, who may not really, um, have the opportunity to engage with people. Always, um, this just bandwidth, um, tons of staff required, uh, to call people all the time to engage with them. So the issue really sometimes involves how to use digital engagement to get to the answers that some of these new rules are going to be addressing. So the member experience as it pertains to digital member engagement is, is that if you take something as interesting as, let's say texting or phone calls, um, there's a certain personalization that every member is going to want to have. That that digital member engagement cannot just be across the board the same, um, it cannot be the same exact phone call. They will get tired of it. Um, people need to know what the benefits are. So in terms of reaching out from a digital perspective, people want to be able to understand what their benefits are and that any engagement has to be ease of use. With omnichannel preferences, there needs to be an individualization when you're um, engaging members digitally. Um, I think anecdotally I would suggest that, um, you know, people are overwhelmed by phone calls, but if that phone call is specific to that particular member, they will be much more likely to respond. Um, there are always access issues. I mean, I think part of discussing digital member engagement involves talking about the um, the good and the bad. Um, there are certain digital literacy issues that would come up regarding using um, the Internet that certain types of digital engagement can solve for. There's of course rural considerations. Not everybody has the Internet, not everybody has cell service so how to really contact people. Um, so there are member experience and access issues as it pertains to digital member engagement. Um, but I think that certain types of engagement can in fact um, be amplified and uh, you know successful um data. So imagine that you're the health plan and you are now gathering tons of information from people and they already are. There are a lot of third party vendors um, that work with the health plans for closing hedis gaps um and work on the star side. Um, they're creating massive data sets. It is really hard to uh, pull in all that data, synthesize it and create a um dashboard that can be actionable um for any topic. SDOH is a huge one. Uh, which supplemental benefits are offered is another one. Um, internally it is often very hard for the MA programs to actually ingest all of that information and then implementation. I think there's some challenges on the implementation side. Uh, plans don't necessarily have the bandwidth as I kind of alluded to, to handle all this data, handle all this new information because what are you going to do with it? Um, so there has to be action plans. And I think one of the issues is if you keep throwing data at the MA plan, um, it may not be able to handle some of all, uh, some of all that information because it's it, it's coming often unstructured. Um, the stakeholders and alignment and program rollout that any new technology, any new, any new product that comes across that of any sort of healthcare organization is going to require an enormous um, an enormous bandwidth. Um, you're going to have dollars spent, people, time spent and you're going to need to have change management um in place. So I think the considerations for digital member engagement are twofold. Right. It's a double edged sword. It's going to allow mass conversations to be happening, a lot of data but it's going to have to be managed in a way that um, can pull out uh, the important information that's coming into the system. Next slide.

Speaker B: Let's transition to Duron here. So Duron, walk us through this timeline and the main business challenges Medicare Advantage plans are currently facing with regards to supplemental benefits, but maybe specifically to the D step population. Um, and if you could, if you could share that with us.

Speaker C: Yeah. First let's go over this um, timeline um so it's amazing how a chain of event happens uh, uh in the market and how it really aligns with what we are doing at active aging. So in 2032 active aging took uh, uh a strategic decision to focus on personalization ah of supplemental benefits in order to improve health and the wellness of members as well as member engagement. We started working on this, engaging with the health plans and building our solution. Then in 2023 as Amy mentioned the GAO report came and suddenly there is a need for really uh understand the utilization. There is a utilization gap in the benefits, supplemental benefits as well as it's not clear the value or the efficiency uh effectiveness of this benefit. So then come the final rule of the CMS in 2024 and basically they say okay now you have to uh act upon these uh um ah gaps or missing data. So now uh uh come forward to 2025. Active aging has now um developed ah algorithms are designed basically to ah um uh capture all the data that is required in order to address this regulation. We help to close the utilization data gaps and basically uh we help um uh the help plans to improve and be ready for uh meeting the CMS requirement. So basically now in 2025 active aging is working with help plans basically uh uh to address regulation, close utilization gap and in general help them to take supplemental benefits to the next level.

Speaker B: So Amy mentioned briefly the product the Active Agent. So how does the Active Agent uniquely utilize supplemental benefits to improve member engagement?

Speaker C: Basically we see three major uh challenges um in this area that help learners are facing Further is the disenrollment rate which is for this SNP it's about 20% a huge number. Second is um ah the drop in ah star rating 10% since 2020 uh2 and the rising health care expenses mainly due to the prevalence of chronic condition. We see every. All these um challenges stem from the member uh disenrollment ah disengagement basically. So we see that the fact that there is no continuous engagement around benefits between the helper and the member causing these uh challenges um to um become uh worse and worse. Now how we handle this Active agent, Our solution basically is a uh AI agent that continuously engages uh with the members around uh targeted supplemental benefit. We ah monitor each member with holistic view and understand its uh ah evolving health and um social needs. Then we offer the right benefit to the right member at the right time. This continuous uh and personal engagement helps to build trust and emotional connection between the member and its health plan. And this helps to improve member uh satisfaction and retention of course help to improve star rating which is the uh key. The member experience is key here and also help uh down the road to improve overall member health and well being. Um.

Speaker A: Yes.

Speaker C: Great.

Speaker B: And before we go to the next question we do have a question in the Q and A. And Amy, you might be best positioned to answer this one. And I don't know if you've seen it, but Wen has a question with regards to Medicare Advantage, sdoh, benefit utilization, and if any of these approaches crosswalk to how state Medicaid or federal ACL is approaching their delivery of their benefits and services.

Speaker A: Yeah, um, thanks doctor. Um, so, uh, you know, I think the answer to your question is it depends, right? I think there's so much information that's flooding in to um, the health plans. And if you look at some of the boots on the ground, some of the third party vendors that are out doing gap closures, some of them are coding and some of them are not coding. So some are capturing Z codes and some are not capturing Z codes and there's not a product ID for every, um, you know, there's not, there's, there's not an easy way that some of the vendors are collecting this information. So it's not entirely always structured. It is often just a big giant narrative of unstructured information that goes back to the plan. Um, and so I think it's, you know, how is the health plan engaging with each of their members? If they're engaging with them, um, using third party vendors to close certain gaps, they're going to get a tremendous amount of unstructured data. Um, if they're pulling uh, data that's submitted from claims that are coming from um, uh, different types of physician groups. If it's a delegated physician group, it's probably much more organized data than if it's a non, um, delegated physician group that's just um, in a value based contract. So I think the answer is going to be it depends. And I think that that's part of the new challenge is that um, the data about SDOH and the data about supplemental benefits is currently very unstructured. I think that's really what the GAO report was really pointing a finger at. I hope that answers the question at least somewhat.

Speaker B: And then we have a follow up from Dr. Dombrowski and a new question from Tiffany which I'm going to try to put into one question. Um, and I think Duron, this is for you and I think it's specific to Active Agent and does it tie into existing resource platforms like Unite Us Health Leads, Aunt Bertha, which are other software and platforms. And then we have another question from Tiffany around does Active Agent also track utilization and outcomes? So both of you might want to take parts of this.

Speaker A: Um, I'll Take the beginning part of the references to Aunt Bertha Health Leads and Unite Us, which are m. Basically resource aggregators for SDOH and other types of community resources. Um, I think that the answer is if the health plan's offering that supplemental benefit, then yeah, it can. Then yes, those types of resources are important. I think the, the issue is that on a, on a plan, um, by plan basis, different types of SDOH benefits are going to be offered and how they are going to offer them and to whom is going to be predetermined by that health plan.

Speaker C: Yes, it's very important to connect between the databases and the actual benefits that our Binya offer to the, to the members. So what was the question? The second question?

Speaker B: Ah, John, uh, the question is, is if the active agent also tracks utilization and outcomes.

Speaker C: Exactly. So this is exactly what we are doing. We are trying to follow up with each member, understand it's um, uh, the way he uh, utilizes these available benefits. We help them with targeted benefits. So it's not just that he needs to decide which is the benefit he wants to do or not. We help him with its process. We reflect to each member the availability of all the uh, benefits but then say okay, let's take this or that uh, benefit. We also measure outcomes and the way that the benefits that are being utilized affect the health and the wellness of the member and this helps us to um, measure ROI and also measure the um, effectiveness of the benefit.

Speaker B: Yes, uh, I think we have a Follow up from Dr. Dombrowski uh, for Amy wondering if there are any federal efforts for data standardization for these benefits and whether previous CMS LTSS data efforts might be informative.

Speaker A: I think the answer is there definitely are um, efforts for data standardization. I um, can't point directly to a source but um, the age of that study, which is about 18, 24 months old really um, leaned into um, probably data standardization methodologies. Um, and I agree that some of the long term stuff will be informative. I think it's all about restructuring how information comes to cms about essentially uh, all things, whether it be on the traditional or the MA side, how they are going to receive and handle SDOH information. The thing of the MA plans is that they need to be far more actionable. Um things that go to CMS is just for you know, billing and coding. The actionable stuff needs to happen at the plan level. So um, I think how to get the information first from the field into the health plan and then from the health plan back up to cms, there's multi steps There and I think it's the actionability that is the key.

Speaker B: Thank you Amy. Uh, just we're going to show a flow of how Active Agent actually works. But just before that, you know wanting to get into Doron's brain a little bit. Just want to know what inspired you know supplemental benefits for the Active Agent platform. And then maybe you can take us into how these um supplemental benefit strategies um can. Can scale and help plans reduce costs and improve retention. So kind of merging two questions duron if you want to take those.

Speaker C: Yes, sure. So first I think the fact that we decided to focus on the supplemental benefits as a key to. To make a difference between uh to really uh differentiate and build uh the connection between helplines and members reflects uh our commitment for um taking holistic approach to member engagement. But it's another point is that the fact that today I believe that uh um uh members see supplemental benefits as a key factor when they decide to uh switch in and out of a health plan. So if, if this. So it's so important for them to switch to decide if they want to stay or we want to go to another health plan then you uh. The health plan has to take this as a key factor in order to improve uh the way uh supplemental benefits are offered to their members making sure they know exactly how to uh to utilize them and it's not easy. Today uh we've been uh looking in the details and we see that some benefits are very complicated to handle especially for people with lower digital literacy. And in this way you can build the trust and you can keep the members satisfied and inside your helpline how we do optimization and at scale. So basically active aging is active agent is an AI agent so is automatically does outreach personalized around personalized uh benefits. Ah it is built in order to not be able to be um uh supported by the care teams or the call center. So basically it's autonomous and in this way we can enable the help plan to do more um reduce the administration burden so they don't need to ah ah um scale their team when they have more and more uh D SNP and um ah MA Plan members available to them. And also uh they can focus more on members with highest risk factors so they don't need to uh handle the majority of the members that can be handled with. With active agent uh in terms of the communication and engagement. But we are also working in a hybrid mode. So this means that uh when we uh detect members that have issues with the engagement we raise flags, red flags to the team The CARE team and ask them to uh, intervene just on time to make sure that these members, the issues are resolved and the MIS member can be, continue to uh, um, uh, be um, happy with the value they receive from the help flow.

Speaker B: Excellent. Thank you Duron. Any questions or follow up for Duron? Okay, what we're going to do now is we're going to show uh, kind of a compare contrast example uh, with an actual member and in a typical um, experience. Uh, so we've made up ah, Alice Andrews here and you can see some demographic data and plan data and her, her clinical situation on the left hand side. Um, so as Amy mentioned, you know, kind uh, of historically supplemental benefits, you know, have been an opportunity for the plan, to promote the plan and the benefits available which have been enticing to members for enrollment. So in this case, uh, Alice was excited to join this MA plan and picked it because there was a wide variety of supplemental benefits that she thought could help her. Uh, after time she started experiencing some challenges. Um, there was no transportation available for non urgent medical care. She missed doctor's appointments. She had forgotten months after enrollment, uh, that she had some benefits that could have actually helped her with the situation. Nor did she remind reminders that these benefits were available and nobody asked her about her condition. And this supplemental benefit plan actually had a free glucometer that could have helped her with her diabetes which she either did not know, remember or forgot. Uh, eventually her outcomes became poor. Her daughter discovered that her supplemental benefits were there, but it was too late. She had already started to pay out of pocket or had succumbed to missing those appointments and having the um, deteriorating health. Uh, Alice and her daughter felt that she was unsupported. Alice switched to a different health plan. This resulted in higher dissatisfaction for the health plan, lowering of the plan star ratings, their overall member retention dropped and their quality scores were negatively impacted. So this is the flow of a uh, disengaged member, um, who had joined a plan based on supplemental benefits available, did not realize the benefits of those plan benefits and it negatively impacted the health plan, uh, and quality reporting as well as losing. And the biggest thing is member churn. Right. So this member churned and went with another plan. Uh, so what we want to show now is uh, an example where the active agent would have been in place.

Speaker C: Yes. Thank you, John. So I think this looks like a nightmare both for Alice and for her health plan. So in the case of active aging we are trying to do it differently. Basically we analyze and assess health and SDOH needs. This Is done continuously. So it's evolved. We know that it's not uh the same all the time. And then we proactively uh engage with the omnichannel outreach. In this case it's phone uh calls and text messages which are personalized and provide recommendation for the benefits. What we see, uh basically that now she is reminded about the transportation. It takes some time. It's not uh that on the first week that we recommend she ah will uh enroll for the transportation. But after few reminders she will actually use them. And then she doesn't um forget to go to her doctor. And then she enrolls with meal delivery services that help her with the um comorbidities that she suffers from. And she also used the free glucometer. Then it uh helps her to by herself to monitor her condition. And her daughter also is a role this. So now Alice is felt supported and she has trust and emotional connection with the health plan and she is now a loyal member and she re enrolled because she feels that she gets the value she expected when she enrolled to this um health plan. Uh in terms of the supplemental benefits the impact on the health plan is clear. Improved star rating which is ah tightly ah related to both um health ah equity as well as customer experience, member experience. Prevention is key, um to reduce unnecessary hospitalization and uh ER visits and uh the higher retention rate this is now is a key factor for health plans. Everyone is talking now that retention now is the new um growth. So now everyone is trying to retain the member instead of bringing or in parallel to bringing new members from outside. Any questions?

Speaker B: Any questions?

Speaker C: Okay.

Speaker B: Uh, Amy, do you want to kind of wrap this uh, kind of concept up and.

Speaker A: Sure. So I think um, putting together uh 2 and 2, um, that the issue as it pertains to supplemental benefits um is engagement and supplemental benefits go hand in hand. Right. Supplemental benefits are intended to increase satisfaction, health, wellness, um, longevity, whatever, whatever. The. The issue is that supplemental benefits is trying to address it. It's over here, engagement is over here they are. It's like hand in glove. So there's measurable impacts that we already understand that supplemental benefits do bring. Um and it increases engagement. So those two things together is really what I think is important as it pertains to um active aging. Um, but in general supplemental benefits, um, they need to go beyond dental vision and hearing. We all know that that is something that is. It's proven. It's why the word advantage is there. It's to continue to keep people safe and well in their home. Um as long as you possibly can do that. Um, keeping people healthy is really the ultimate goal. Um and then of course it's personalization. Um, we don't just want to throw the same thing at all the same people. We don't want silver sneakers for our bed bound patients. We want to start thinking about the individualization. Um and that really dives into the social determinants of health. It dives into the chronic illnesses. So how can we make sure that personalization is happening at a high level? Um it's certainly what Medicare Advantage has in mind. Um, there is no doubt um that when they are engaging with the members Medicare Advantage is keeping that um, at the front of mind. But I think that's something that needs to be measured. Are the benefits that we think are supposed to be happening that are personalized are they actually going to have an impact? Um and then there's a regulatory push um for the data and the member engagement. I think this is so critical. Um and it's really what has um, uh sort of inspired a really deep interest um from my perspective is that um. I think it is a data um waterfall M. Acquiring information, um, processing information and then sort of giving it back to um whoever wants it in some um utilizable way I think is a really big issue. And um. I think the unfunded mandate in some ways that came through after the GA report with the new rules from CMS is really just um. You know it's, it's. It's uh almost an impossibility given some of the subsystems that are currently in place and the way that um the plans are currently absorbing information or not absorbing information. Um so I think we're going to have to rely on AI. I think we're going to really have to rely um on uh more sophisticated um analytics tools dashboarding um and uh in order to get that maximal supplemental benefits effectiveness and the personalization is just going to require a lot of data. And so we're going to be looking to um lots of organizations who can really impact that and get data um to the stakeholders that need to have it.

Speaker B: Thank you Amy. And we do have a few questions. Um, I'm going to start with uh, Amy Lee um, who has asked about active aging and does active aging work with various wellness provider and act as a hub or offering as wellness services.

Speaker C: So we took um uh first it's a good question. We took ah um decision to be uh an AI ah layer uh for the health plans and not coming with the actual benefits. So the benefits Are available health plans, they know how to select them. We are helping the help plans to manage uh the benefits better. So we don't just uh recommend uh targeted benefits for each member. We also help the help plan to know which benefits are uh more effective and positive uh ROI and which are less effective in this way when they do the bidding every year they know exactly which benefits to uh select moving forward and which to drop. Ah if you are a provider of these benefits you are um, have uh hidden agenda. Ah so you cannot be uh, a judge or can be unpartial when you provide the recommendation.

Speaker B: Two more questions. So um, how has Active Agent been received by plan members? Follow up my assumption meaning Tiffany's assumption would be it is well received but I am curious if it is at the point where members expect expect the active agent experience.

Speaker C: So we are early stage. We are building our um solution and currently in the process of closing a pilot with some help plans and we'll uh, be happy to discuss further with anyone that is interested to uh work with us.

Speaker B: And the second question is how are sqh needs assessed and in a way that is non burdensome to the patient member.

Speaker C: So uh, here some of this is our IP of course but uh, we are handling different uh type of information coming from different sources. Some of them available online, some of them coming from the member and from the health plan. So we are trying to build this as a uh solution to really assess ah specifically for benefits but also holistically of the member to understand his needs. Um, basically this is everything is done in the AI model. So um, this is exactly where we, this is the work we've done during the last four years.

Speaker B: I think this is a good time for any additional questions. I did drop a link and I don't know if everybody was able to see it to the active agent page. Um, maybe somebody could drop me a question in the questions and answer to tell me if they saw that link because I don't know if everybody is seeing the uh, responses in the Q and A chat. Um, but I did put it in as a response to Amy's question. So you can have additional information on Active Agent by going to the page. Um, okay, I'm going to. Thank you Amy. We're going to just uh, while we're, while we're waiting for more questions. Thank you. K. Uh, would love to field additional questions and additional 14 question additional. Got a couple here but not seeing the link. Okay, got it. Okay, great. Okay, so as far as go forward activities, I know we have various Stakeholders here from, um, um, plans, benefit providers, uh, providers, provider groups, uh, and we're grateful to have everybody with such a diverse audience. Uh, so our suggestions are really. Familiarize yourself with the new CMS requirements. This is a big shift for supplemental benefits. Um, evaluate your supplemental benefit strategies and how you fit into that ecosystem of delivery, the programs, and now the new reporting requirements, including these, these letters and utilization data that must be furnished. We encourage you to contract Jerome, um, at Active Aging, uh, to learn more about his platform. And myself and Amy, we'll, you know, be happy to continue the conversation, um, and help you as you devise your strategies around this, this new opportunity, uh, and the area of supplemental benefits. Uh, we do have some extra time here, so any other questions we have seen? We are not seeing any additional questions. We are seeing a thank you. Thank you.

Speaker C: Oh.

Speaker A: Ah. Uh, okay, I see that.

Speaker B: Good one. Take it, Amy.

Speaker A: Okay, so what does supplemental benefits not include? So it's. Okay. That is actually so, um, helpful. That is a great question. So supplemental benefits do not include medical benefits. So there's the medical benefits and then there's the supplemental benefits. So if you think about it, health care is not a supplemental benefit. And the plans that have the supplemental benefits, they delineate those themselves based on their own choices. The dental, the vision and the hearing, those are all supplemental benefits. Those are types of supplemental benefits. And then there's a whole slew of other things that include that have been sort of tucked into the supplemental benefits. Anything that is increasing health and wellness. And I think actually your question is really, um, almost like a lead in for the following conversation, which is where is there room for innovation? The room for innovation in the healthcare space is probably in what is known as supplemental benefits. These are sort of, um, nebulously defined. Um, there is some suggestion that they may increase quality of life, um, wellness, prevention, all these different things. There are huge numbers of things that are considered to potentially be supplemental benefits, but they have to be ascribed. Thank you. Mental health support is a great one. I was actually going to even suggest caregiver, um, supports. Right. If you're taking care of a lot of a chronically ill, um, family member, um, there are platforms out there that will then be purchased by the health plans to help support caregivers that may be, um, an important service, uh, for that particular group of patients that may have certain types of, um, uh, chronic illnesses. So to answer your question is it's almost like there's medical benefits and then there's everything else. And it's A supplemental benefit, if the health plan says it is and if it meets certain requirements for, um, those two different types of, uh, supplemental benefits. It's concerning, um, that innovation could be squashed, um, which can happen in a setting. I mean, I'm just going to say it out there. Traditional Medicare is not necessarily the most innovative space because everything has to have a code, right? There has to be a code and a diagnosis. On the MA side, um, there's a lot of flexibility about what could potentially be, um, something that the health plan might cover. And there's a lot of innovation in that space saying, you know, there may not be a code for this, but this is something that, um, a member may, in fact, um, have a lot of benefit from. So, um, I think that's the. That's the. That's the major. That's the major difference is there's medical and then there's everything else. And then that's sort of subdivided into things that are kind of health, medical and then things that are not. But you're more supportive. Um, so mental health support. Absolutely, I agree. What is the difference between preventive care and supplemental benefits that support prevention? Ah, so, um, understanding that Medicare Advantage must pay for everything that traditional Medicare pays for, that is the basis for, um, the baseline. And then anything over and above that kind, um, of goes into the advantage part of the Medicare Advantage. So on the traditional Medicare side, there's preventive care that are specific services that m. Uh, Medicare has determined to be preventive medicine, like AAA screenings. Um, certain annual wellness visit goes under preventive care. Um, there's a whole slew of things like immunizations, this, that, and the next thing. So to answer your question, which is what is the difference between preventive care and supplemental benefits that support prevention? Um, is preventive care is kind of a prescribed terminology. Um, the supplemental benefits that support prevention. Like if you're thinking, um, uh, vitamins or, uh, silver sneakers or sort of things like that, those would fall under the supplemental benefits because Medicare is not already covering those. That's a. I think that's a basic gist, but I think that sort of covers it. Unless somebody else wants to add Doron or John to that. Like, when I think about preventive medicine, I think about it as preventive services that are directly medical and then everything that is sort of under that preventive umbrella, um, that's not directly healthcare that Medicare would otherwise not cover, that would be a supplemental benefit.

Speaker C: Yeah. Preventively.

Speaker A: Hope I answered that. It was complicated.

Speaker C: Usually is, uh, care gaps that, um, should Be closed. So this is medical, and you have. Then you have the rest, which is supplemental benefit, which are not medical and do not need any doctor's, uh, um, prescription and CPT code, as you mentioned.

Speaker A: Yep.

Speaker B: I think you guys covered it well. Sana. Yeah. Thank you for those questions. Are there additional questions? Let's see here.

Speaker A: Um, okay, we've got a few more. Here we go. All right, Dr. Dombrowski, um, Amy mentioned supplemental benefits as enrollment enticements and drone mental. Supplemental benefits are a key factor to switching to other MA plans. Uh, there are concerns from patients and providers that the supplemental benefits recruits patients, but then more expensive medical expenses like surgery procedures and rehab are often denied. So how balance the tension between the two? Marketing versus reimbursing large spend. Thank you for that largely philosophical question, Dr. D. Um, I think, um, I will just push, um, my own thoughts, um, without a tremendous amount of opinion or commentary. I think it's really clear, um, that supplemental benefits certainly are a marketing tool, and the GAO has called that out. Uh, Medicare has called that out. This is not an opinion. Right. This is sort of like it's from the Federal Register, it's from commentary that's been going back and forth between CMS and gao. Um, so the question then is, if you want to get people into your system, right, into your health plan, how do you keep them there? Um, you know, you can use supplemental benefits as a enticement to come in there, but you need to make sure that people are taking advantage of them, they know about them, and from a health system perspective, it reduces the churn, which, by the way, is a benefit to all members. You know, moving from health plan to health plan is not healthy. Right. It's not healthy for the system, you know, at large, and it is not healthy at an individual level. Um, so I don't want to dive too much into sort of like the, um, you know, like the. The philosophy, the. Too philosophical and. And too opinionated outside of that. But I think it is really clear that all the new rules, the GAO report, the new rules that are coming down the pike are in response, I think, to what you are alluding to here, which is, let's not think of them as enticement benefits. Let's think of them as true benefits. Um, so, yeah, that would be how I would answer that.

Speaker B: Amy, do you think. I mean, the direct correlation I see is the. Is the letter in that it's kind of forcing the, uh, tension by saying, I don't know if you used it for marketing or not. But you did offer it, and it didn't get used. And it didn't get used. So we're gonna. We're gonna. We're going to m. Bring visibility to that. And we're gonna. And. And we're gonna know that you're gonna want to be held accountable.

Speaker C: You don't.

Speaker B: You're not gonna want to show in a letter that you. You offered 55 benefits and one got used, um, to a member. And I think that's kind of forcing. Force, forcing the tension and bringing visibility and light to the. To the gap. And plans are probably gonna have to make decisions on, you know, their benefit portfolios going forward, which is how active aging contributes to measuring the utilization of which ones are actually being used versus not which feeds right into the data utilization reporting as well as the letters

Speaker C: and the effectiveness of this benefit and

Speaker B: the effectiveness roi, roi, quality scores.

Speaker C: Sometimes the benefits are very expensive and give a minimal value.

Speaker B: Yes.

Speaker C: Um, to the plan and to the member.

Speaker B: We love this discussion, uh, and conversation. By the way.

Speaker A: Um, can you hit. Yeah. Can you just throw slide 5 up there real quick? John, just while we're answering, um, Sana, uh, from Rubetection's, um, next call.

Speaker B: I'm sorry, stop me because I can't see my slide.

Speaker A: Timeline. Timeline. The timeline. Okay, timeline. Yeah, let's answer, um, Sana's. Um. Okay. Would reminders to provide care and wellness, uh, to provide care and support wellness fall under supplemental benefits? Like, is the call itself also a supplemental benefit? Great question. Um, or is it care management support to support prevention as a supplemental benefit? So you're. Let me. I'm going to just make sure I'm not thinking of it correctly. And then I think, Jerome, this is definitely a question for you, which is, are the reminders themselves a benefit?

Speaker C: No, I think the reminders is type of engagement method that the helpline has to, uh, provide and to cover. It's logistic and it's not, uh, part of the benefit. So supplemental benefits are. During the breeding process, the supplemental benefits have been approved by cms, so they need to know that these benefits provide the value as is highlighted here in this, uh, slide, by the way. So only these benefits can be, uh, provided. Engagement method and marketing, uh, are not considered benefit.

Speaker B: We have one last question, uh, around how common and large are MAPD plans prior employers offer to retirees? Do you see that one, Amy?

Speaker A: I do. I feel like I'm just going to answer. I'm not sure I understand the question entirely.

Speaker C: Um, I can answer this.

Speaker A: Uh, okay, let Me. Let me throw in one thing, and then Duran, I'll hand the mic to you. Um, the supplemental benefits. Um, there was a great, um, a great article, um, from, uh, you know, some of the. The folks that are really, um, looking at insurance numbers. Um, I can't remember the name of the consulting company, but they were looking at exactly how much money is spent per beneficiary, um, on supplemental benefits. Um, it's just over. It's just north of about 200 bucks per member. So if there's 8 million UHC Medicare Advantage folks, they're spending about $400 million a year. Um, 400 billion. I think it's whatever. The numbers are very large. But per beneficiary, supplemental benefits account for about just north of $200 per, um, beneficiary per year. And I don't know if that was the question.

Speaker C: Dennis even understand the question. So you are talking about PAYO employers. Um, ah, MA plan. So from Mike's knowledge, uh, this. This is a small portion of the MA plans and shrinking. So it means that less and less, um, uh, employers are offering this map, uh, plans to their retirees. Uh, so this is the answer. Basically. It's. It's. It's less and less common. It used to be m. Much more common thinking in the area of 20%, and now it's dropping to 10%. Something like this. Okay.

Speaker B: And I know we are past time. Can we fit in one more answer about Sharon's question? Is the federal reimbursement to MA plans increased based on the supplemental benefits offered? Or is the marketing and enrollment increase the financial incentive for health plans to offer supplemental benefits?

Speaker A: I'm trying to find that one.

Speaker B: The very last one.

Speaker A: Okay. Yeah. Oh, here we go. Is the federal reimbursement to MA plans increase based on the supplemental benefits offers? The marketing, enrollment increase, the financial incentive to help. Oh, um, I m. Think that's the answer is, um. It depends. So, uh, the rebate program is based on the delta between, um, between how much the plans come in at the rates that they want to, um, ask the federal government to pay them that delta between what Medicare would have paid and what their health plans coming in. That rebate is just a rebate. And the health plans can choose to spend that how they want. Um, I would make sure and cross this by John and Jerome, but there is no relationship. I think, like, if we offer more supplements, supplemental benefits, we will get paid more. That's on them. No, that's their spend. Their spend to make.

Speaker C: Yeah. This is being defined the rebates are closed during the bidding process each year and it's not related to the actual benefits that are being offered.

Speaker A: Right.

Speaker C: The health plan. Then take this number. And they have to decide which benefits they want to promote, ah, the next year based on the rebate. Ah, ah, money they received.

Speaker A: Right.

Speaker C: Okay.

Speaker A: Yeah. Amy, just quickly. Um, it's a Milliman report. And if you contact me afterwards, I will send you that, that, uh, report from MILLIMAN about the 200 per member.

Speaker C: Yeah.

Speaker B: With, with that we've gone over time. Great conversation.

Speaker C: Thank you very much.

Speaker B: Our contact information is up. If you have any follow ups, we're happy to answer them. And thank you so much. Matter for, um, for this opportunity.