A new OIG report details how Medicare Advantage members are far more likely to conduct a home healthcare visit with a provider they don't have a relationship with—good news for startups like Dispatch Health and Heal.

The number of Medicare Advantage plans offering social health-focused benefits increased three-fold over the past year, but their members aren’t using them—we explore how tech from SDOH startups like Papa can boost uptake.

The retail giant filed paperwork to provide virtual care in 37 states as it decelerates brick-and-mortar expansion plans. We think it could market audio-only visits to its massive Medicare population since pandemic-era coverage for these visits could be permanent.

MA plans are growing in popularity for beneficiaries because they often come with extra benefits over original Medicare, such as vision, hearing, dental, and wellness programs. 42% of all Medicare beneficiaries—more than 26 million people—are enrolled in MA plans, a rate that has steadily increased over the past decade, according to the Kaiser Family Foundation (KFF).

FM: It's hard, and it’s even harder if you're not limiting yourself to Medicare Advantage [a value-based payment initiative in which private health plans receive capitated payments from Medicare for each beneficiary enrolled]. For these primary care startups, it’s hard to start in value-based care, but it's possible.

The health system reported that less than a year into the program, its 30-day readmission rate dropped from 16% to 6% among its high-risk Medicare patients. Expanding access to care. The Mayo Clinic adapted its remote chronic care program during the pandemic to monitor lower-risk COVID-19 patients.

Why Walmart’s clinics could succeed in Florida: Many Medicare-aged consumers with chronic conditions visit Walmart’s Florida retail stores regularly. Florida has one of the largest Medicare populations (aged 65+) in the US: Medicare beneficiaries make up about 21% of Florida’s residents, per KFF’s tracking. For comparison, only 12% of Utah’s residents are on Medicare.

In January 2021, it partnered with multistate managed care organization CareSource, which offers Medicaid and Medicare Advantage plans.

In September, One Medical closed its $2.1 billion acquisition of Medicare Advantage-focused competitor Iora Health. That means one month of its Q3 2021 earnings likely accounts for a large portion of its newly acquired members. Iora Health serves over 39,000 senior patients, which added on to One Medical’s 621,000 members (as reported at the end of Q2’21).

And this week, the CMS proposed to extend telehealth flexibilities through 2023—which would allow providers to continue offering telehealth to Medicare patients without any concerns around reimbursement. D2C virtual care companies are also branching into different specialties to cater to the diverse needs of healthcare consumers—and it’s been paying off.

The data: Most (~70%) physicians fear they’ve missed signs of drug use disorders during the pandemic since routine medicare care was disrupted, per a November 2021 Quest Diagnostics report surveying 500 primary care doctors. Specifically, 75% of doctors say they are concerned about the misuse of opioids.

It launched its insurance arm last October, and it’s been growing its Medicare footprint via partnerships with Oak Street Health and Clover Health. Delving into the employer-sponsored healthcare marketplace seems like the next logical step for the retail giant.

In September 2020, Walmart struck a deal with Medicare-focused primary care company Oak Street Health to integrate its primary care services into three major supercenters. But here’s one big signal for why it chose Epic as its EHR partner: In May of this year, Walmart acquired telehealth provider MeMD.

Thirty-four percent of US citizens were covered by either a Medicare, Medicaid, or military healthcare plan in 2019, per the US Census Bureau. The CMS has been ramping up efforts to get digital health tools into more of its beneficiaries' hands.

The 29-page plan also includes initiatives for capping Medicare members’ out-of-pocket costs, shortening drug manufacturers’ exclusivity periods, and reducing regulatory barriers for lower-priced generic medications.

And earlier in August, The Choose Home Care Act of 2021 was introduced, which aims to expand Medicare members’ access to clinical-grade care at home. Even though Baxter and Hillrom are not traditionally digitally-driven healthcare companies, their massive existing footprint in hospitals and health systems could give the combined entity a leg up.

Medicare beneficiaries were telehealth superusers: About 44% of Medicare beneficiaries used telehealth, while only 31% of adults on employer-sponsored plans opted for virtual care. 63% of adults used telehealth as a preventative service, prescription refill, or routine visit for a chronic illness. And 8 in 10 respondents said they would likely use telehealth in the future.

A 2019 analysis by New York eHealth Collaborative (NYeC), the nonprofit organization running the network, estimated that the use of SHIN-NY would reduce the state’s healthcare spending by $160 million to $195 million annually, for all types of payers including Medicare and Medicaid.

And Bright Health offers specialized plans for Medicare Advantage (MA) patients, including one with $0 PCP copays and $0 prescription copay on some medication.