Avēsis, our government benefits administrator, manages dental and eye care benefits for nearly 300,000 Medicare Advantage beneficiaries through relationships with six regional and national health plans. We deliver a full-service, third-party administrative solution that includes claims adjudication, network management, and clinical support.
Medicare Advantage, or Medicare Part C, is a government-supported health benefits program with a unique set of regulatory requirements. Avēsis has been operating in the Medicare Advantage market since 2007 and understands how we can add value for your plans through our experience in administering dental and vision product offerings.
While Medicare Advantage plans differ in coverage options, one thing is certain: plans that offer dental and vision care offer significant value for you and your beneficiaries. In fact, ancillary benefits may be considered essential to succeed in the market. Analysis by the Kaiser Family Foundation shows that 68 percent of Medicare Advantage plans in the market today offer dental, vision, hearing, and fitness benefits.1 The latest research conducted by J.D. Powers and Associates on consumer satisfaction with Medicare Advantage indicates that the most important factors consumers use to make their plan decision are coverage and benefits, followed by provider choice.2
Medicare Advantage programs that include vision and dental care are a win for both the member, who has a greater chance of maintaining good overall health, and the health plan, which earns a reputation for comprehensive and quality care.
There is wide variation in coverage for ancillary benefits, ranging from preventive coverage only to full coverage for dental restorations and dentures or corrective lenses for vision. The scope of your benefits should be directed by your data and your goals. Analysis of utilization and claims data can help you understand what benefits are most needed or wanted by your members, and complaint data can reveal where your plans fall short.
We typically use this type of data to help clients design provide beneficiaries with the greatest value at the lowest efficient cost. High-demand dental benefits include quarterly periodontal cleanings and dentures. On the vision side of the equation, adding lens options like blue-light blockers, photosensitive lenses, and anti-glare lens technology are helpful and popular in this competitive market.
There are three easy sources of data to evaluate which of your dental and vision benefits drive greatest value for your members. This starts with enrollment data. Simply comparing enrollment between plans after each open enrollment period can help you determine which plan designs are most attractive in your target markets. Enrollment data might not tell you which parts of your dental or vision benefits helped attract the member. For this, you’ll want to ask your third-party administrator to help you analyze:
- Complaint data: At Avēsis, we regularly evaluate complaint data by line of business, client, and market to help us understand the need for improvement in operations, network, and client plan design. For example, our data shows that in 2019 and 2020, fewer than 0.5 percent of all Medicare Advantage claims we processed resulted in a member complaint.3 Fewer than 18 percent of these complaints were about benefits and coverage. We specifically analyze these trends by market and plan so we can help our clients and discuss potential improvements.
- Utilization data: High utilization among those who have these benefits shows just how important it is. A 2020 report produced by the Commonwealth Fund showed:
- With dental coverage, 61 percent of Medicare Advantage beneficiaries had a dental visit in the last year. Without, only 42 percent had seen the dentist at substantial out-of-pocket expense.4
- With vision coverage, Medicare Advantage enrollees spent $331, versus $415 for those without.4
Avēsis has the advantage of seeing benefits trends across the country that we can share with our clients. For example, corrective lenses are nearly always a value-added benefit in Medicare Advantage plans. To make this benefit even easier to use, we manage a cost-efficient prescription glasses kit for our clients’ Medicare Advantage members. Beneficiaries simply choose a pair from the kit supplied to our participating providers. The simplicity of this plan design has helped us realize utilization of the eyeglass dispense codes that is nearly double that of other Medicare Advantage markets where we do not offer this kit.5
The bigger picture: higher utilization means members reduce their risk of falls and other common vision impairment-related injuries, so the health plan pays less in the long run.2
Research conducted by J.D. Powers and Associates in 2020 on consumer satisfaction with Medicare Advantage indicates that the second most important factor consumers use to make their plan decision is provider choice. Unfortunately, participating in a Medicare Advantage provider network comes with perceived hassles: administrative burdens, unrealistic quality goals, and low reimbursement rates. As a result, many providers may not participate in these networks, which can make it hard for your beneficiaries to get easy access to an in-network doctor. This is particularly true for dental networks.
To fill the gap, many third-party administrators in the Medicare Advantage market contract with rental networks. While this is a strategy often used in commercial dental programs, there are downsides to using them for government benefits. This is largely because neither the health plan nor the government benefits administrator have a relationship with the dentists through which they can deliver educational information, benchmark reports, and alternative payment incentives typically required as part of a Medicare Advantage or Medicaid plan.
In contrast with some Medicare Advantage ancillary benefits managers, Avēsis contracts directly with their network of Medicare Advantage dentists. Internal analysis shows that an average of 87 percent of rental network dentists already participate in the nation’s largest rental network, which greatly simplifies our recruitment process.7.Having them participate fully with us allows for improved relationships. It also allows us to offer provider education, gives us access to their data for analysis, and improves the benefits for our members. And it gives you a broad, stable, discounted network that helps increase enrollment and utilization—which helps save on expensive medical complications resulting from neglected oral health. Let us show you how it works.
The CMS Star Rating system was developed to be an objective and a reliable indicator of quality and performance for those seeking Medicare Advantage plans. Between one and five stars are awarded to Medicare Advantage plans based on how well they perform in five domains that include preventive care, chronic disease management, communication and customer service.
Health plans get financial benefits when they earn higher star ratings. For example, improvement from three stars to four stars for a plan yields benefits for health plans:8
- 134 percent more value through extra benefits and better rebates
- 8 to 12 percent increase in plan enrollment, year over year
- Increase in revenue from 13.4 to 17.6 percent
Star ratings are not only a boon for reimbursement rates. Consumers use these to determine the quality of their Medicare Advantage plan the same way they’d use any other rating system. More stars bring more enrollees to your plan.
Avēsis can help you improve your Star ratings in a handful of ways including helping you improve and maintain high diabetic retinopathy exam (DRE) rates for your members with diabetes. An annual DRE can detect serious diabetic eye diseases and help prevent them.9 Avēsis monitors DRE data for our Medicare Advantage clients to help ensure their members are receiving this potentially sight-saving exam.9 For example, one health plan client asked us to help ensure they attained a rating of three star or higher for their DRE as part of their overall Star improvement strategy. We implemented an outreach campaign in 2018 that resulted in the plan achieving the desired three-star rating in one market with an end of year score of 68.61 percent of eligible members receiving the test. We helped them achieve a four-star rating in another market with 76.39 percent of eligible members receiving the annual DRE