The Medicare Advantage (MA) opportunity isn’t one that has happened overnight for home care providers, with some industry insiders even describing it as a “slow burn.” In more recent years, a shift has begun to take place, however.
Although MA has become a bigger piece of the overall Medicare program puzzle, home care only stepped into the picture in 2019. The previous year, the U.S. Centers for Medicare & Medicaid Services (CMS) issued a final rule that mandated non-medical in-home care services as a benefit for MA plans.
CMS continued to stretch the flexibility around the rules, allowing coverage for benefits that “have a reasonable expectation of improving or maintaining the health or overall function” for individuals with chronic conditions.
In the early days, many providers were eager to lean into the new opportunities, but they had to navigate a learning curve on the part of MA plans. Such was the case for Senior Solutions Home Care, according to CEO and founder Kunu Kaushal.
“It so happened that we had a managed care organization here in the state of Tennessee, and they had an MA plan that they didn’t quite know what to do with, or how to participate with personal care,” Kaushal said during the Home Health Care News Medicare Advantage for Home Care Virtual Summit. “We quite literally picked up the phone and started calling everyone at the managed care organization, asking if they were participating and how we could get involved. Our entry has been searching and looking under rocks up to this point.”
Brentwood, Tennessee-based Senior Solutions Home Care is a company that provides personal care services, transportation solutions and nutrition support. The company has more than 20 offices across the state.
Like Senior Solutions Home Care, Synergy HomeCare faced similar challenges. The company responded by taking the initiative to educate MA plans.
“[We’ve] been really consulting with health plans that we could get in front of and just simply educating them on home care, the industry and the value that we could bring to their plans,” Rich Paul, chief partnership officer at Synergy, said at the HHCN event.
Synergy is a Gilbert, Arizona-based non-medical home care franchise that operates roughly 170 franchise locations nationwide. The company offers companionship services, in addition to personal assistance, housekeeping, live-in care and 24-hour home care services.
Currently, Synergy is working with a mix of both national and local MA plans. The design of the benefits varies significantly, depending on the health plan. With some MA plans, the company offers typical home care services, focusing on activities of daily living (ADL). With others, the company offers transportation assistance.
Lately, Paul has noticed that MA plans have begun to evolve — letting go of strict definitions surrounding benefit offerings.
“When this was first being offered, health plans were really coming out and saying, ‘Here’s the defined benefit,’” Paul said. “There wasn’t a lot of flexibility in the design of that benefit. What we’re starting to see is that, although they initially started out with a very conservative approach in terms of the type of model and what they wanted to offer, we’re seeing a little more receptivity to thinking differently about the benefits they’re offering.”
One thing that’s important for providers to remember is there’s no “cookie-cutter” approach, according to Ryan Iwamoto, president and co-founder of 24 Hour Home Care.
“Although CMS has created a menu for these MA plans, no plan has to do all of it or even certain portions of it,” Iwamoto said. “The actual plans determine the best value for them and what they want to do. I think the last year or two … has been an exploratory time for those brave plans that were willing to be the first to market.”
Los Angeles-based 24 Hour Home Care is an independent, non-medical home care provider with 20 locations spanning California, Arizona and Texas.
Iwamoto noted that having continued dialogue with 24 Hour Home Care’s MA plan partners — which include SCAN Health Plan — about what services are working out and which ones aren’t has been the key to successful collaboration.
“It’s totally different than that payer that you never see, you don’t ever talk to. You send them an invoice, which is a lot like long-term care insurance,” Iwamoto said. “You can’t really partner with them. I think the MA strategy is about finding healthy partnerships in a new way.”
For context, of the 738 plans offering primarily health-related supplemental benefits in 2021, 429 offer in-home support services, doing so across 36 states and Puerto Rico, according to data from Washington, D.C.-based ATI Advisory. That’s a 93% increase compared to 2020.
These days, providers are seeing MA plans being more receptive to engaging with home care. Paul credits the COVID-19 emergency and the spotlight that has been placed on home-based care for this change.
Another change providers have been seeing is that MA plans are more open to adjustments to rates
“When this was first rolled out, health plans wanted to do no more than dip a toe in the water,” Paul said. “They were really concerned about the financial risk and what that would mean.”
Despite these positives, there are still challenges for home care providers working in the MA space.
“Because they either don’t have the experience or … [because] they like the idea of having the benefit without really any understanding of the burden and how difficult it is, there have been some [conversations about having] very short hours,” Kaushal said.
This creates a situation where there’s not enough flexibility and control between the agency and the recipient of that care, Kaushal noted.
Ultimately, MA will be important to home care’s continued evolution.
“I think home care has to be dynamic,” Kaushal said. “I think we have to be able to react to the needs of health care.”
The post How the Medicare Advantage Landscape Has Evolved for Home Care Providers appeared first on Home Health Care News.
