Health plans big and small have recognized the value home-based care providers bring to the table in terms of avoiding costly hospital readmissions and supporting America’s seniors as they age in place. But forging initial relationships with insurers — especially top Medicare Advantage (MA) players, such as UnitedHealthcare (NYSE: UNH), Humana Inc. (NYSE: HUM) and Blue Cross Blue Shield — is no easy task.
Luckily for at-home care providers, there are several ways to win the attention of health plans, experts say.
Some of the most successful tactics include going to plans with turnkey provider coalitions, demonstrating a consistent ability to deliver quality outcomes and outlining exactly how home-based care can boost member enrollment.
“I think I would boil it down to three main things,” Anne Tumlinson, founder of Washington, D.C.-based research and advisory services firm Anne Tumlinson Innovations (ATI), told Home Health Care News. “First of all, you have to be able to demonstrate that you can deliver a high quality product and that you’ve got some kind of program that’s going to be at least minimally focused on keeping people out of the hospital.”
Establishing connections with insurers has been a priority for home care agencies, in particular, since the Centers for Medicare & Medicaid Services (CMS) announced in April it would allow some non-skilled in-home care services as supplemental benefits for MA plans starting in 2019.
While the announcement came relatively late in the annual benefit filing cycle, some major players, including Anthem, Inc. (NYSE: ANTM), have already crafted new packages featuring home helper, transportation and adult day center services.
In addition to sitting down with HHCN to discuss what health plans want from long-term care providers, Tumlinson highlighted the information last month during the 2018 Home Care Association of America’s annual leadership conference.
“This is an exciting time,” Tumlinson said at the event. “The best thing you can do right now is educate yourself about how Medicare Advantage plans work and what they’re looking for — because it’s not always what you think.”
Besides relaxing the rules on supplemental benefits, CMS also tweaked its benefit uniformity framework, or its guidelines for how MA health plans can target benefits to groups of enrollees who have certain clinical diagnoses.
Broadly, the Medicare Advantage program gives federal dollars to private insurers to offer plans covering basic Medicare benefits, plus a number of extras, such as vision, dental or, moving forward, certain home care services. Health plans generally get paid the most for high-need individuals who are older, sicker and with lower-income levels.
Roughly one-third of MA beneficiaries reported having difficulty with at least one activity of daily living in 2015, according to an ATI review of the Medicare Current Beneficiary Survey. Similarly, about 45% reported being diagnosed with at least three chronic conditions, while 7% reported having some form of cognitive impairment.
“The population that [at-home providers] serve is the population that plans get paid the most for,” Tumlinson said.
That means home care agencies that are collecting and making sense of data as part of their daily operations will have a leg up on competition when it comes to establishing health plan partnerships. The same applies for agencies using predictive analytics tools to avoid emergency department visits and avoid hospitalizations.
MA plans don’t get to directly pocket any savings from avoiding hospital readmissions, but doing so helps them bid against other insurers as part of an annual process.
“They’re looking for non-medical long-term services and supports providers who can support them in their goals of delivering a high-quality product and that keeps people out of the hospital,” Tumlinson said. “Ways you can demonstrate quality and ability to deliver results, that’s kind of just the price of entry.”
Humana Chief Medical Officer Roy Beveridge recently emphasized the value of data and understanding “what’s going on in the home” during a presentation at this year’s Home Health Care News Summit.
Leveraging data may seem like a no-brainer tip, but it’s one that may prove challenging for some agencies. The home care industry has traditionally not been very active in that data and analytics arenas, experts have pointed out.
In some cases, health plans may be skeptical of data brought to them by home care agencies. That means providers should be well-armed with objective, peer-reviewed studies that back up home care’s value as well.
Health plans and ‘turnkey’ relationships
Apart from data, health plans will also be more likely to form relationships with at-home care providers that have fleshed out arrangements with other health care organizations.
Lafayette, Louisiana-based LHC Group (Nasdaq: LHCG) is one of the most successful examples of home-based providers partnering with hospitals and health systems. LHC Group is currently the preferred in-home health care partner for 76 health system and 337 hospitals across the country.
Minnesota-based in-home care provider Lifesprk, which has a partnership with Utah-based health system Intermountain Healthcare, is another successful example.
“To whatever extent possible, [providers] need to make it easier on plans by creating high-value networks that they can bring to them,” Tumlinson said, noting that the strategy is somewhat akin to shopping around for a fully furnished versus empty apartment.
Home care agencies with other provider partners should approach health plans as a team, she said. Agencies should also make sure to reach out to independent physician groups, many of which operate hand-in-hand with health plans as part of their work.
Understanding how health plans compete
Data and provider coalitions are important, but the priority for most MA health plans is enrollment and growing their membership base, which is the primary way that these plans can boost their bottom line. On a basic level, plans achieve higher enrollment figures through lower premiums, more supplemental benefits and lower cost sharing.
“Ultimately, what health plans really want is lives,” Tumlinson said. “The reason Anthem did what they did was not because they were looking to cut costs in their hospitalizations, though that’s important. What they’re doing is testing out a new strategy for attracting and retaining enrollees.”
Anthem’s recently announced supplemental benefits packages, available throughout many of its health plans starting next year, offer eligible members a choice of six different services, including 124 hours a year of home helper services or $500 in safety devices.
CMS has a treasure trove of publicly available data on contracts, plans, enrollment numbers, service area and MA contact information online, Tumlinson said. Home care agencies should take advantage of that material, reflect on the services they offer, then go to health plans knowing definitively how and where they can best provide value.
“If I were a Medicare Advantage plan, I’d be really interested in talking to a home care company that knew they were already serving a lot of my enrollees,” Tumlinson said.
Written by Robert Holly