Medicare Advantage (MA) plans are allowed to cover a range of in-home care services for the first time in 2019, but few insurers are going to do so, according to recent analyses of plan offerings. Experts believe these types of benefits could gain a lot more traction in the next two to three years, however.
In 2019, just 3% of MA plans will offer in-home support services such as personal care and housekeeping, according AARP. The Washington, D.C.-based organization offered an analysis of Medicare Advantage Landscape Source Files from the Centers for Medicare & Medicaid Services (CMS).
Other types of newly allowed supplemental benefits will be offered on a larger scale, AARP found. For instance, about 13% of plans will cover family caregiver support services such as respite care or counseling. And about 47% of plans will start to cover nicotine replacement therapy.
A separate analysis of the CMS data was conducted by D.C.-based health care consultancy Avalere. At least 40% of plans will offer new supplemental benefits next year, Avalere found. The most common new benefit will be nicotine replacement therapy, offered by 1,653 plans. In-home support and personal care services will be offered by 107 plans.
CMS first announced that MA plans would be able to offer these new benefits last April. This did not leave much time for insurance companies that offer Medicare Advantage to develop 2019 benefits packages including these new options. Insurers that were too pressed for time might choose to introduce these types of benefits for the first time in 2020.
More than 50% of MA plans will likely offer at least some of these new supplemental benefits as of 2020, according to Kenny Kan, a vice president at Avalere who was formerly enterprise VP and chief actuary at insurance giant Humana (NYSE: HUM).
The home care benefits in particular should “resonate well” with MA insurers, which are trying to encourage more provision of care at local sites rather than the hospital, Kan told Home Health Care News.
“I think we are going to see a lot more next year,” Anne Tumlinson, founder and CEO of health care consultant firm Anne Tumlinson Innovations, told HHCN. She is encouraged by the Avalere and AARP findings, noting that MA insurers had a lack of clear CMS guidance on the new benefits, in addition to the short timeframe for incorporating the benefits into 2019 plans.
“To me, the fact that any plan is doing anything with these new benefits [for 2019] is kind of a miracle,” she said.
Rule of 8
Although he is confident that more Medicare Advantage plans will offer the new in-home care benefits in the future, Kan also emphasized that the pace of adoption will not be uniform.
“What we are seeing at Avalere is that plans are at varying stages of thinking about the issue,” he told HHCN. “Some are exploring the issue and some are a lot further ahead.”
Home care companies are also at different stages in strategizing about how to work more closely with the MA insurers in their markets.
“I’ve actually spoken to a few of those home care companies,” Kan said. “What we’ve observed and suggested, and what they want to think about, is how well do they believe they can coordinate care?”
That is, they need to have systems and processes in place to integrate with the larger health care ecosystem, to be able to flag issues and drive more targeted interventions to keep beneficiaries healthy and costs down. One example would be a home care company that equips its aides with iPads.
“They go in, they take notes, they show some followups are needed, and one of the followups could be this person really needs to see a doctor,” Kan said. “If that record is able to connect to a care hub, a care coordination framework, that would really appeal to a Medicare Advantage company.”
Having a payer outreach strategy is crucial for home care providers that want to win Medicare Advantage business in the future and potentially help shape the new supplemental benefits packages, Kan emphasized.
To connect most effectively with an insurance company, it might be helpful to keep in mind the “rule of 8.” These are eight questions that Kan believes insurers need to be asking themselves as they try to determine which new benefits to offer and how to do so. They are: what is the benefit; what is the targeted sub-population; what triggers benefit eligibility; how long is the benefit; how to measure return on investment and price; how to file and submit bids; how to change IT systems and administer the benefit; what happens if ROI results are not good.
“When you deal with payers, many are interested in understanding what is the proof of concept and ROI?” Kan said. “Granted, data can be limited [about these new benefits]. Be able to answer that as best as you can.”
From his days at Humana — one of the largest MA insurance companies in the nation — Kan has an insider’s perspective and knows that these are crucial considerations for an insurer. He also believes that Humana could be an early and active mover, when it comes to offering the new home care benefits in MA.
That’s because the Louisville-based company recently acquired a stake in Kindred at Home and Curo Health Services, making it a partial owner in the largest home health provider and one of the largest hospice providers in the nation. The idea is to leverage these acquisitions to better coordinate care and manage costs for Humana’s MA population.
Anthem (NYSE: ANTM), which recently announced how it will be offering some of these new benefits in 2019, is another pace-setter.
With these large companies incorporating the new benefits, that could spur more action for 2020 as other insurers try to keep pace.
“I think plans will be incentivized to offer more, the question is, what kind of benefits will they offer?” Kan said. “Their strategy really needs to be finalized by March [2019], because health plans need to build that into their rates.”
Written by Tim Mullaney
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