SNFs with significant veteran census under MA plans should monitor utilization patterns closely, as reform aimed at eliminating this dual-payment waste could redirect veteran admissions toward VA Community Living Centers or VA-contracted facilities. Facilities with historically high veteran populations may need to proactively assess their VA provider agreements alongside their MA contracts to protect census from a potential policy-driven shift in care routing.
Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial duplicative, wasteful spending if veterans in MA plans predominantly seek care through the Veterans Health Administration (VHA) system. Using national data, we found that veterans increasingly enrolled in MA between 2016 and 2022, including in a growing number of MA plans in which 20 percent or more of the enrollees were veterans. Notably, about one in five VHA enrollees in these high-veteran MA plans did not incur any Medicare services paid by MA within a given year—a rate 2.5 times that of VHA enrollees in other MA plans and 5.7 times that of the general MA population. In 2020, the Centers for Medicare and Medicaid Services paid more than $1.32 billion to MA plans for VHA enrollees who did not use any Medicare services, with 19.1 percent going to high-veteran MA plans.
— Health Affairs, 02 November 2024
Ma, Y., et al. “Medicare Advantage Plans With High Numbers of Veterans: Enrollment, Utilization, and Potential Wasteful Spending.” Health Affairs, 02 November 2024. https://doi.org/10.1377/hlthaff.2024.00302
Report: CMS Paid $1B+ to Medicare Advantage Plans With Veterans Who Did Not Use Services
“As veterans navigate the increasing complexities of healthcare options, our research aims to inform policymakers and stakeholders about the urgent need to optimize the use of federal resources in veteran care,” said Jose Figueroa, MD, an associate professor of health policy and management at the Harvard T.H. Chan School of Public Health. “This is particularly important given the substantial budget constraints that the Veterans Affairs system is currently facing.” Authors said the data shows that the government is paying for healthcare twice for veterans using Medicare and VA, and that the VA and CMS need to better coordinate care to avoid wasteful spending.
— McKnight’s Long-Term Care News, 05 November 2024
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✔ Monitor rates and payer trends
