Innovative care model: MGB receives $4.6M grant to study healthcare at home

In this issue:

• Innovative care model: MGB receives $4.6M grant to study healthcare at home
• 2023 Medical Loss Ratio (MLR) Rebate Information
• Minimum Creditable Coverage vs Medicare Creditable Coverage: What’s the difference?
• Upcoming survey to get customer feedback
• Toolkit: Share these resources with your clients

Innovative care model: MGB receives $4.6M grant to study healthcare at home

The Massachusetts Executive Office of Health and Human Services (EOHHS) has recently awarded Mass General Brigham a $4.6 million grant to conduct a comprehensive assessment of providing short-term rehabilitation care in the comfort of patients' homes. It's estimated that nearly 2,000 patients in Massachusetts hospitals are facing extended wait times to transition into skilled nursing facilities.

Since 2016, the Healthcare at Home program at Mass General Brigham has addressed this issue by implementing a range of innovative solutions that bring hospital-level care directly to a patient's home. Previous research on the effectiveness of home hospital programs has shown promising results for patient outcomes. The upcoming study will have 150 patients receive short-term rehab care at home while 150 will receive care at skilled nursing facilities. 

“If successful, this care model may lead to a complete transformation of how we deliver advanced rehab care to our patients,” said David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home program. 

In Mass General Brigham’s Healthcare at Home program, admitted patients receive care from a traditional care team enabled by the latest in remote monitoring and medical technologies. Patients meet with a clinician and are set up with everything necessary for a successful care experience, including monitors to remotely track vitals and a tablet to connect with their care team via video 24/7. 

To learn more, visit Mass General Brigham's Healthcare at Home program page. 

2023 Medical Loss Ratio (MLR) Rebate Information

Mass General Brigham Health Plan will provide MLR rebates for fully insured plans offered to individuals and small employer groups for 2023.

Our rebates reflect changes to the administration of the risk adjustment program under the Affordable Care Act. These changes required us to recognize risk adjustment payments from previous years in calendar year 2022, which is part of the three-year average considered in our 2023 filing. This resulted in our MLR being below the threshold in Massachusetts and led to rebates for CY2023, to be paid in 2024.

Mass General Brigham Health Plan met the minimum threshold for large employer group plans, so no rebates are required.

As you know, many of our small employers purchase their insurance directly through Mass General Brigham Health Plan. Small employers and individuals can also purchase their Mass General Brigham Health Plan insurance through intermediaries such as HSA Insurance (HSA) and the Small Business Service Bureau (SBSB) or through the Massachusetts Health Connector. Here is how rebates will be provided:

• Rebate checks will be provided by Mass General Brigham Health Plan to small employer groups who purchase their coverage directly from Mass General Brigham Health Plan.
• Rebate checks will be provided by Mass General Brigham Health Plan to individuals and small employer groups who purchase their coverage through the Health Connector.
• Rebate checks will be provided by the Small Business Service Bureau (SBSB) to individuals and small employer groups who purchase their coverage from SBSB.
• Premium credits will be provided by HSA Insurance (HSA) to individuals and small employers who purchase their coverage through HSA and are active clients. Rebate checks will be provided by HSA Insurance (HSA) to individuals and small employers who purchase their coverage through HSA but terminated their coverage.

Notices to subscribers and employers will be mailed by September 13, 2024.

Please visit our website for more information and an FAQ at MassGeneralBrighamHealthPlan.org/mlr and direct any questions to your sales or account executive.

Minimum Creditable Coverage vs Medicare Part D Creditable Coverage:
What’s the difference?

Changes to the Part D creditable coverage threshold for CY 2025 has sparked questions about the difference between Medicare Part D Creditable Coverage (MCC) and Minimum Creditable Coverage. Due to the Inflation Reduction Act, CMS enriched the Part D benefit significantly, capping the max out of pocket (OOP) cost per member to $2000 for CY 2025. This raised the threshold that Commercial Rx Plans need to meet or exceed to remain compliant and at this time all of Mass General Brigham Health Plan's Commercial Plans are compliant. 

Below is a breakdown of Medicare Part D Creditable Coverage and Minimum Creditable Coverage:

Medicare Part D Creditable Coverage refers to prescription drug coverage that is at least as good as the standard Medicare Part D prescription drug coverage. If you have other prescription drug coverage, from a current or former employer, that is considered creditable, you may not face a late enrollment penalty if you decide to enroll in a Medicare Part D plan later on. This is important for individuals who are eligible for Medicare and want to make sure they maintain their current coverage without incurring penalties in the future.  

Minimum Creditable Coverage (MCC) is a requirement under Massachusetts state law, designed to ensure that residents have a basic level of health insurance coverage. Plans must meet specific standards set by the Massachusetts Health Connector, which includes comprehensive benefits and limits on out-of-pocket costs. Individuals who do not have a plan that meets MCC may face penalties when filing their state taxes.

Key differences
 
1. Purpose:

• Medicare Part D Creditable Coverage: Specifically relates to Medicare Part D prescription drug coverage.
• Minimum Creditable Coverage: A requirement for all residents, 18 years and older, in Massachusetts to have a minimum level of health insurance coverage.

2. Applicability:

• Medicare Part D Creditable Coverage: Applies to individuals who are Medicare eligible but have other coverage through a current or former employer. 
• Minimum Creditable Coverage: Applies to all residents of Massachusetts, 18 years and older.

3. Consequences of non-compliance:

• Medicare Part D Creditable Coverage: Not having it can result in penalties for delaying enrollment in Medicare Part D.
• Minimum Creditable Coverage: Failing to have it can lead to financial penalties during tax filing.

In our upcoming broker newsletter, we will share more FAQs on this subject to further clarify and reinforce the information.

Upcoming customer feedback survey

At Mass General Brigham Health Plan, we strive to provide our customers with the best healthcare coverage and experience. With that goal in mind, we are excited to once again conduct a survey with our broker and employer customers. It’s an effective way for us to better understand how we are doing and develop new initiatives that offer real value to you, your clients, and their employees.  

As in the past, you and your clients will soon receive an email from our Customer Experience Team with a link to the survey.  Please be on the lookout for it.  This survey will collect feedback on various aspects of your experience with Mass General Brigham Health Plan. Your feedback is greatly appreciated, though optional, and will not have any impact on your relationship with Mass General Brigham Health Plan services. Thank you in advance for your support!  

Tips for sharing these articles and resources

• Include in an email blast to your clients
• Post on your social media or blog

Articles and resources for your clients

• Stay well and healthy: Get caught up on all your recommended vaccinations 
  Suggested text to share with clients: "Back-to-school is a time for new beginnings and fresh perspectives. Parents stuff backpacks with school supplies in the hopes that their children will stay strong and confident for the year ahead. One of the many challenges parents anticipate, especially with so many kids gathered indoors, is the spread of illness that tends to occur once kids return to the classroom. Continue reading for more insight from Dr. Jim Hellinger, Medical Director at Mass General Brigham Health Plan and Infectious Disease Specialist. Read more."

• • • • Video - Understanding your health plan: HMO vs PPO vs EPO
        Suggested text to share with clients: "What is an HMO? Do I really need to pick a PCP? Understanding the nuances between health plan types can feel like cracking a secret code. Luckily, Mass General Brigham Health Plan has a great video that breaks down the differences between an HMO, PPO, and EPO. Give it a watch here."