CMS' new Medicare rules may be fueling Walmart, Amazon deals

Recent changes to Medicare Advantage plans that expand service offerings may be prompting collaborations among retail giants like Walmart and Amazon with health insurers, according to Forbes.

CMS revised its rules on MA plans to allow the inclusion of supplemental benefits like coverage of non-skilled, in-home support and assistive devices — or what it called "additional services that increase health and improve quality of life."

CMS also bolstered its definition of "primary health related" as it applies to the MA  program. "Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization," CMS said. These services extend as far as wheelchair ramps, dehumidifiers or rides to the local grocery store.

Insurers that support MA plans — Aetna, Cigna, Humana, UnitedHealth Group and Blue Cross and Blue Shield — may now be able to address social determinants of health to develop new ways of keeping seniors healthy and out of hospitals.

"This new flexibility will allow MA plans to broaden the scope of services tailored to assist patients — services like safety adaptations to a patient's home, transportation to medical appointments or an emergency room, meals and other benefits that will assist patients, especially those with chronic conditions, with services that might be needed but generally are not covered in Medicare," Kris Haltmeyer, vice president of health policy and analysis for the Blue Cross Blue Shield Association, told Forbes.

The MA rules update also opens the door for health insurers to work with drugstores and retail operators who market products that serve their senior populations' needs. For example, CVS Health and Aetna are teaming up, while Humana is taking a 40 percent share in Kindred Healthcare's home division. Amazon is exploring creative uses of its grocery store chain Whole Foods, and Walmart is in talks with Humana.

Bill Frack, L.E.K Consulting managing director, told Forbes he views CMS' goal under the MA changes as more "focused on in-home monitoring," and that  "companies in home health like Amedisys, Kindred/Humana are more likely to benefit than the giants."

"However, Walmart and Amazon could add relevant services to their home delivery repertoire," he added.

More articles on payer issues:
Survey: Majority of Americans believe ACA marketplaces are 'collapsing'
CMS axes Medicare Advantage star rating measure: 5 things to know
Insurer payments to climb 3.4% under new Medicare Advantage rule: 3 notes

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