CMS Now Pays More for Medicare Advantage Members with Dementia. Is Your Plan Ready?

Effective January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) is reimbursing Medicare Advantage plans up to $5,000 per member per year for patients with a diagnosis of dementia.

CMS requires cognitive screenings for Medicare members as part of annual wellness exams, and yet only 16 percent of Medicare members are screened regularly during their annual visit.

And it’s not because members are resistant or hesitant. In fact, 87 percent of Americans aged 50 and above rank “cognitive health” as a top three health concern.

Medicare patients who receive regular cognitive assessments during annual wellness visits.

Americans aged 50+ who rank “cognitive health” as a top three health concern.

Understanding the cognitive status of your members has an enormous impact on how you manage
their comorbidities.

Diabetic members: cognitive impairment decreases their likelihood of exercising regularly by 29 percent and reduces their likelihood of adhering to their recommended diet by 38 percent.

Chronic Obstructive Pulmonary Disease (COPD) members: cognitive impairment doubles the risk of not completing pulmonary rehabilitation.

The Savonix Medicare Advantage solution makes it easy for your plan to fulfill CMS requirements and qualify for additional reimbursement to support the care of your Medicare members diagnosed
with dementia.

The Savonix Complete Medicare Advantage Solution Includes:

Our cognitive assessment tool, Savonix Mobile, for members runs on any mobile device. Members can administer the assessment on their own, or it can be administered by a nurse. Using our member engagement portal, your Medicare members can access test results immediately accompanied by a detailed, member-friendly analysis.

About Test Results

Our HIPAA compliant dashboard allows you to view results, monitor changes, and manage access to Savonix tests. It can be accessed remotely from any mobile device or web. Through the dashboard, you can also access:

  • Our on demand, personalized care plan generator, SavonixCare, combines the results of the member assessment with care plan components to streamline the clinical diagnosis and treatment process.

  • Our analytics tool designed by our team of data scientists and neuropsychologists, Savonix Insights, provides in-depth cognitive, demographic, and behavioral reports ranging from the population to individual level information.

More Information About Risk Adjustment

Including Dementia in the Part C Medicare Risk Adjuster: Health Services
For over 30 years, Medicare Advantage plans have had their federal revenue adjusted to reflect the expected cost of their enrollees. The risk adjustment mechanism currently used is the Hierarchical Condition Category (HCC) risk adjuster, which assigns a risk score to each beneficiary based on their diagnoses and demographic characteristics. Currently, there are 83 HCCs in the Centers for Medicare and Medicaid Service (CMS)-HCC model.

Learn more from Milliman, a global independent risk management, benefits and technology firm, about Including Dementia in the Part C Medicare Risk Adjuster: Health Services Issues.

The Real-World Medicare Costs of Alzheimer Disease: Considerations for Policy and Care
A study by Milliman found that nine years before death, Medicare costs for patients with Alzheimer’s are only 11 percent higher than for beneficiaries without Alzheimer’s, after adjusting for the risk of comorbidities. The study also found that in the last year of life, patients with Alzheimer’s incurred Medicare costs that were $1,342 less than those of nondementia beneficiaries.

Learn more about The Real-World Medicare Costs of Alzheimer’s Disease: Considerations for Policy and Care study.

Partner with Savonix to assess your members and increase your reimbursement. Contact us.

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