The 2019 CMS guideline changes provided health plans with a new opportunity to enhance over-the counter (OTC) benefits, particularly for beneficiaries with chronic conditions such as heart disease. Through the development of a chronic disease component tailored to members’ needs and conditions, health plans have an ideal opportunity to maximize customer satisfaction while improving outcomes for beneficiaries. At Convey, the CMS changes allowed us to enhance our suite of supplemental benefits solutions, known as Miramar:Benefits, to promote products that improve health outcomes.
This innovative approach aligns perfectly with the movement toward value-based care and its primary objective: to keep populations healthier at a lower cost. It allows Convey to be a better partner in patient-centered care as we invest in more customized benefit designs to address specific chronic conditions.
“When we leverage OTC offerings by focusing on populations with the highest need, our health care plans and their members win,” says Assura Chauhan, vice president of clinical services for Convey Health Solutions.
Let’s look at chronic heart disease. Consider that 57% of Medicare Advantage (MA) beneficiaries have high blood pressure and 41% have high cholesterol, both of which contribute to heart disease. We can make a significant impact for the populations we serve simply by focusing on the prevention and treatment of chronic heart conditions.
Heart disease and stroke are among the chronic health conditions with the highest cost. They cause a third of all deaths in our country and cost our healthcare system $213.8 billion a year. Without proper disease management, they can potentially lead to severe health complications and worse health outcomes.
When designing an effective supplemental benefit program, identify and include access to specific products that support your plan’s wellness initiatives for those who have a chronic heart condition such as:
Home diagnostics
Known as the “silent killer,” high blood pressure usually has no symptoms. For this reason, the value of monitoring blood pressure at home on a regular basis cannot be overstated. The American Heart Association (AHA) recommends home monitoring for all individuals with high blood pressure to help their healthcare provider determine whether prescribed treatments are effective. Convey offers both desktop and wrist blood pressure monitors in its OTC product listing.
Personal Emergency Response Systems (PERS)
Seniors with one or more chronic conditions like ones that affect their heart; have severe falls at significantly higher rates than those that do not report any such conditions. Having medical alert products and services available to your membership may enable you to counteract the increasing cost of treating falls, and your membership to feel a greater sense of independence.
Smoking cessation
The dangers of smoking are well known. It is the leading cause of preventable death and a confirmed risk factor for heart attack and stroke. OTC products, such as nicotine gum, lozenges and patches, can help a smoker quit for good. The health benefits of quitting begin in the first hours that one stops smoking and can continue for decades.
Weight loss products
Significant weight gain can change the structure of your heart and its ability to pump blood, increasing the risk of heart failure. However, losing weight can reverse this potentially deadly process, boosting heart function, lowering blood pressure and improving metabolism. Weight loss products and a holistic approach to nutritional programs are valuable additions to OTC offerings.
Aspirin
Many health care providers prescribe a daily low-dose aspirin regimen to thin the blood and help prevent the formation of blood clots. For their patients, aspirin is an essential part of their preventive care and a valued OTC item. As the most ordered product offered to MA members under Convey’s OTC home delivery benefit, over 15 million aspirin pills are fulfilled annually.
Omega-3 fatty acid supplements
Health care professionals agree that food is the best source of nutrients over vitamin supplements. However, one supplement, omega-3, has been widely associated with decreased risk of heart disease. Based on available data, the AHA recommends that patients with documented heart disease consume about 1 gram of EPA + DHA (types of omega-3 fatty acids). While the preferred source is fresh fish containing omega-3, the AHA maintains that supplements may be considered, but stresses the need to consult with a physician first. The Convey OTC benefit offers fish oil capsules and gummies with omega-3 and DHA, while the nutrition program covers meals designed to support these high-risk members.
While it is essential that beneficiaries with chronic heart disease work closely with their health care team in the treatment of their condition, health plans can help provide the necessary support for members to make lifestyle changes, reduce the risk of complications, and achieve wellness goals. This is another advantage for the countless members who already consider their health plan’s OTC benefit as a highly useful and meaningful feature. What better way to connect with them than through a program that is already widely popular? “Plan members are very excited to know they have this free benefit, and plans can build on that excitement to ensure their members take the necessary steps to manage their conditions and protect their health and quality of life,” Chauhan said.
As the fastest growing supplemental benefit for Medicare Advantage Organizations (MAOs), OTC has become highly successful. Through increased utilization of OTC benefits, members receive enhanced disease management, which in turn leads to improved health outcomes, enhanced member satisfaction, and reductions in the cost of care.
Research has already shown that every $1 spent on OTC products has resulted in more than $7 in savings in the US healthcare system. When plans make the most of this benefit for members with chronic conditions, the payoff in terms of improved health and savings will be significant. About 117 million people in the US have at least one chronic disease, with 75% of adults over age 65 having multiple chronic diseases.
“With greater flexibility in the supplemental benefits landscape, MA plans are becoming more robust,” states Tom Pelegrin, chief revenue officer and senior vice president for Convey. “This will lead to greater product innovation, heightened competition, and improved care management.“
To learn more about Miramar:Benefits, and how we can partner to address your beneficiaries with chronic heart disease,