Nearly three years ago, when insurers were in the early days of experimenting with new offerings under CMS’s reinterpretation of “primarily health related” supplemental benefits, very few plans were offering benefits specifically geared toward “memory fitness.” Now, a new Faegre Drinker analysis shows that these benefit offerings will be featured in more than 1,300 plan benefit packages (PBPs) next year —an increase of 38% over 2022.
Henry Mahncke, Ph.D., CEO of Posit Science Corp. — the maker of BrainHQ online brain training exercises — says this trajectory reflects a growing recognition by insurers that the mind and body are connected and a growing interest in whole person care. And Mahncke says it’s notable that one in four plans in the Faegre Drinker analysis that offer a physical fitness program now also offer a memory fitness program, making it the fastest-growing category of fitness benefits. “It’s exciting for us to see that more and more plans are realizing, ‘If I’m offering a physical fitness benefit, I need to be offering a memory fitness benefit as well. My customers want and expect that a supplemental benefits package is going to take care of their brain and body,’” he tells AIS Health, a division of MMIT.
While memory fitness benefits are filed in PBPs as separate from physical fitness, insurers and their marketing partners are often promoting them as complementary to one another, observes Mahncke. “Once you get past the basic information [such as] whether a beneficiary’s provider is in the plan, supplemental benefits are what make or break [plans] in a competitive market. And what we see is that sales agents and brokers and marketing materials talk about integrated mind-body fitness and see that customers respond to this notion,” he says. “It ends up being a helpful shorthand for plans who are trying to distinguish” their plans from the many products that include physical fitness benefits.
Insurers are also largely offering these as population health benefits, making them available to all enrollees, according to Mahncke. And CMS has been very supportive of memory fitness offerings, he says. In its April 2018 memo on expanded supplemental benefits, it highlighted a “standalone memory fitness benefit” as one of nine potential services that could be offered starting in 2019. And more recently, CMS began asking plans to specify in their bids what brain exercises they are using, which Mahncke says is a “helpful clarification” because it “sets the stage for CMS to make sure in general that these are good, valid proven brain training exercises going forward.”
Although there are many “brain games” available online or through a smartphone app store, “they don’t really have a path into the health care system,” asserts Mahncke. Moreover, very few of them have the studies to qualify as “health related” per CMS’s standards, while BrainHQ is backed by more than 100 studies showing significant health benefits after as little as 10 hours (often achieved at a rate of 20 to 30 minutes a day, a few times a week), according to Posit Science.
Mahncke is quick to cite the ACTIVE study, which was funded by the National Institutes of Health (NIH) and published in 2013. The large, randomized controlled trial tested certain cognitive interventions on older patients and featured an earlier version of the BrainHQ exercise Double Decision, in which the user must spot a target in the middle of the screen while also identifying a target in the periphery, and eventually improves their processing time. In that study, 87% of Double Decision users showed meaningful increases in the targeted cognitive ability, and the study demonstrated that Posit Science training drove improvements that were significantly better than other types of cognitive exercise.
But more recently, there have been additional studies in the area of dementia risk reduction, such as one in Australia looking at a combination program of physical fitness, diet and BrainHQ, and one conducted by researchers at Stanford University and the University of Rochester showing positive results in the use of BrainHQ among people diagnosed with mild cognitive impairment, according to Mahncke. The NIH also is enrolling patients in in a large, randomized trial that will feature BrainHQ and rely on a “much more sophisticated analysis of the transition to dementia than had been available,” he says. While insurers have yet to share data on what they see in their own health outcomes, Posit Science hopes to see that happen in the next couple years, he adds. Mahncke is also hopeful that CMS will explore the collection of member-level data around usage of memory fitness, physical fitness and nutritional meal delivery, which could serve as further evidence supporting the impact of memory fitness and whole-person care on dementia progression.
For 2023, Posit Science has partnered with 18 MA organizations that will feature BrainHQ memory fitness programs, up from three in 2020. SummaCare is one insurer that will continue to offer BrainHQ as a memory fitness benefit next year. According to SummaCare’s Kerri Towsley, director of product development and market intelligence, the Ohio insurer began offering the benefit in January and has had a positive experience thus far.
Towsley tells AIS Health that SummaCare chose to offer the benefit because of the science behind it and for the added differentiation if gives the plan, which also offers a separate physical fitness benefit. “SummaCare is in the most competitive environment in the country in terms of the number of plans offered,” she says. For 2022, there are 82 total individual (non-Special Needs Plan) MA plans offered in Summit County, Ohio, where SummaCare is located. For 2023, that number has increased to 87, compared with the national average of 29 plans. “We love to innovate to differentiate from other plans. We were the first plan in Ohio to offer BrainHQ on all plans,” she says. (Anthem, Inc. started offering BrainHQ in 2020 as part of its Essential Extras package from which members select their supplemental benefits.)
“The science behind it was also very convincing. Our Chief Medical Officer, Dr. Charles Zonfa (who has since been promoted to oversee all quality at Summa Health) was a big supporter for adding this benefit to our Medicare Advantage plans. He called it a ‘no brainer’ to add,” says Towsley. “Personally, Alzheimer’s and dementia runs in my family, so I was excited to get this added to our plans to help our members not only stave off the onset but also to keep members feeling their best cognitively (along with physically).”
Although member enrollment with the program has been low, that’s not unusual for a new benefit, and the insurer is currently brainstorming ways to make members more aware of the offering, says Towsley. Nevertheless, the members who are using it are making progress. “At our halfway point in July, BrainHQ shared with us the progress that our members are making in each cognitive category. The goal is 20% improvement, but our members surpassed the 20% in each category,” she tells AIS Health.
And for 2023, Aetna will for the first time offer BrainHQ’s programs to select MA plan members. Other new supplemental benefits for next year include preloaded debit cards with a quarterly allowance to use toward the purchase of over-the-counter items and/or a combination of “support services” and the delivery of fresh food boxes to qualifying members.
“As a former caregiver for my parents, I saw firsthand how important it was to keep their minds active and engaged as they aged,” explains Christopher Ciano, president of Medicare for Aetna, a CVS Health company. “Mental health is just as important as physical health to a person’s overall wellness. That’s why adding memory fitness as a new supplemental benefit on some of our 2023 plans seemed like a natural complement to our other benefits designed to promote physical health.”