For skilled nursing facilities, this research underscores the heightened risk that MA plan design imposes on their most clinically complex residents.
SNFs caring for high-acuity residents under MA should anticipate greater barriers to authorization for necessary services and narrower referral networks that limit patient choice and facility access. Proactive care planning, robust clinical documentation, and strong payer relationships are essential to protect both care quality and reimbursement for this vulnerable population.
How Medicare Advantage Is Shaping the Care of Older Adults with Serious Illness
The Medicare Advantage (MA) program currently insures half of Medicare beneficiaries, and yet there are major gaps in our understanding of how it is impacting older adults, particularly those with serious illness and at the end of life. This population is particularly vulnerable to lapses in care quality in MA given their complex health care needs and challenges navigating MA cost-control mechanisms such as prior authorizations and narrow networks. I will present a framework to consider how MA is influencing care delivery and outcomes for older adults, a review of what we know about the impact of the dramatic growth of MA plans, and emerging data on the experience of older adults with serious illness in MA. This session will highlight best-practices regarding use of claims and population data to evaluate the MA program.
— Innovation in Aging, 21 December 2023
Ankuda, Claire. “How Medicare Advantage Is Shaping the Care of Older Adults with Serious Illness.” Innovation in Aging, 21 Dec. 2023. https://academic.oup.com/innovateage/article/7/Supplement_1/411/7488435.
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
