Flexing its scale and technology knowhow, nationwide online home care network CareLinx has launched a new, turnkey offering for Medicare Advantage (MA) plans looking to incorporate non-skilled home care as a supplemental benefit.
Announced Wednesday, Medicare At Home will allow MA plans to partner with CareLinx in a Medicare-compliant fashion so they can offer home care services, shown to prevent hospital readmissions and reduce total episodic health care costs. In addition to service delivery, Medicare At Home will also help MA plans gather and make sense of data related to how their members use home care services.
The U.S. Centers for Medicare & Medicaid Services (CMS) made the decision in April to allow for certain non-skilled, in-home care supports as supplemental benefits under the Medicare Advantage program for 2019. So far, about 270 health plans have capitalized on the newfound flexibilities for supplemental benefits next year, covering about 1.5 million MA enrollees, according to CMS.
Big MA players such as Humana Inc. (NYSE: HUM) and home care providers alike touted the move as a major victory in the battle to address social determinants of health and keep older adults in their homes for as long as possible. Actually being able to take advantage of CMS’ MA changes has been difficult, however, largely because of the fragmented nature of the home care industry and the relatively small window plans had to finalize their 2019 benefits packages.
Medicare At Home from CareLinx will make the process easier for MA plans, CareLinx CEO Sherwin Sheik told Home Health Care News.
“Everyone sees a lot of promise, and MA plans want to start incorporating non-skilled home care,” Sheik said. “But when it comes down to how they effectively do that at scale, there have been a lot of questions asked. We heard those questions loud and clear.”
San Francisco-based CareLinx — purchased in September 2017 by Generali Global Assistance, part of the Generali Group — has the scale to launch an MA-focused product that could appeal to plans. Founded in 2011, CareLinx connects older adults and families looking for home care services to its pool of more than 300,000 vetted, licensed and tech-enabled caregivers.
“That’s put us in a pretty unique position to be a preferred partner as health plans are looking to incorporate non-skilled into their benefits designs,” Sheik said. “Under one [service level agreement], plans are able to basically roll this out in a Medicare compliant way. When you’re a large or mid-sized plan in multiple geographies, just contracting at the ZIP-code level, the franchise level, is daunting.”
The 2021 ‘explosion’
CareLinx has already been working with select MA plans on the home care front with “best-in-class” success, Sheik said. Medicare At Home draws upon the lessons learned from those relationships.
In general, he said, CareLinx’s model is able to coordinate home care benefits at a roughly 25% discount price compared to traditional agency models.
As part of the new Medicare At Home offering, CareLinx updated its technology and built a specific home-visit checklist catered to MA plans. It also tweaked the type of data it’s capturing when caregivers enter client homes.
“On the technology side, when we’re capturing all this data on members in the home, it’s getting rolled up very efficiently into a population dashboard specifically designed for Medicare Advantage care management programs,” Sheik said. “The Medicare At Home product line is a combination of a new technology offering, plus all our processes and implementation knowhow per the Medicare rules and guidelines.”
Despite interest and demand, it’s unclear how many MA plans will actually offer in-home support services such as personal care and housekeeping in 2019. Just 3% of MA plans will offer in-home supports as supplemental benefits, one AARP analysis found. A separate analysis from Washington, D.C.-based consultancy firm Avalere found that 40% will.
Plans that went live with non-skilled home care supports for 2019 likely did so in controlled approaches to gain insights and design better programs for 2020, Sheik said. The “explosion” of opportunity for the home care industry will likely come closer to 2021, he said.
“This change of Medicare allowing for non-skilled home care — which is really addressing the social determinants of health such as meals, mobility, social isolations — makes for a really exciting time in our industry,” he said. “You now have the government seeing Medicare, seeing the value of actually investing in and deploying social types of services, rather than clinical types of services, to reduce readmission rates and total episodic cost of care.”
Written by Robert Holly