With a small fraction of Medicare Advantage (MA) plans set to offer newly allowed in-home services in 2019, many home care agencies are still unsure what the changes mean for them. But one prominent Southern California insurer is offering the benefits and says the new rules create opportunities for agencies of all sizes.
“We’ve benefitted from even the smallest of agencies coming in, and we’ve forged some great relationships,” said Jill Selby, corporate vice president of product development of Long Beach-based SCAN Health Plan. “Button up your offerings and start reaching out to health plans and watch your business grow.”
Serving more than 195,000 members in California, SCAN is a one of the nation’s largest not-for-profit MA plans. It’s also in the roughly 3% of MA plans set to offer supplemental non-skilled in-home care services in 2019.
The Centers for Medicare & Medicaid Services (CMS) announced in April that Medicare Advantage plans would be allowed to offer non-skilled in-home care as a benefit for the first time starting in 2019. Because of time constraints, few insurers were able to develop new benefit packages by the deadline. But SCAN had a leg up. From 1985 to 2004, it operated as a social HMO, allowing it to offer clients in-home benefits.
“We had an advantage because my playbook was wire-framed out already,” Selby told Home Health Care News, noting the company also has an MA special needs plan that allows for in-home care. “We already had all of the contracts in place [so] we could pivot from what we already had.”
Next year, many of SCAN’s MA plans will include two new in-home benefits: “Home Advantage” and “Returning to Home.”
Home Advantage acts as a fall prevention plan, Selby said. SCAN will send an occupational therapist into a beneficiary’s home to make sure the living space is safe. That includes giving professional recommendations to prevent injury, such as adding grab bars or moving dishes to lower shelves.
Already, the benefit has yielded new partnerships with home health agencies in SCAN’s market.
“We did have to go out and find either a home health agency that employed licensed occupational therapists or if there was a home care agency that had tentacle contracts with occupational therapists,” Selby said.
The Returning to Home benefit is a readmission prevention plan triggered by a stay of at least one night in an acute hospital or skilled nursing facility. Ideally, reduced readmission rates will be a measure the benefit’s success in the year to come, Selby told HHCN.
The benefit includes 16 hours of in-home personal care and 84 meal deliveries per year, as well as support from a care navigator.
Personal care includes everything from bathing to meal preparation to laundry and beyond, while meal delivery schedules can be customized for each client.
While SCAN employs care navigators to help establish services, clarify discharge plans and answer questions, caregivers are provided by outside home care agencies, many of which already had existing contracts with SCAN because of the organization’s previous and current in-home service offerings.
“What we’re doing is just broadening the pool of people they’ll get to serve,” Selby said. “We’ll continue to feed [these agencies], and when they reach capacity, we’ll continue to grow with other home care agency contracts.”
Experts predict new supplemental MA benefits will take off in 2020. By then, more than 50% of MA plans are estimated to offer some sort of new supplemental benefits, according to Kenny Kan, a vice president at Avalere and former enterprise VP and chief actuary at insurance giant Humana (NYSE: HUM).
It’s growth that SCAN is already anticipating.
”I think you’re going to see a lot of plans really plunging into that space to the extent that Medicare lets you,” Selby said. “I definitely think [benefits] will grow, especially for SCAN.”
Still, it’s unclear how many beneficiaries will take advantage of SCAN’s new offerings — but national studies show demand for similar benefits. About 57% all MA members say they want their plans to cover assistance at home, according to a survey by HealthMine Medicare, a service company that provides research and analytics to health plans.
“We’re certainly going to do our part to push it out, but we also want members to be aware before the crisis that they have these benefits available to them.”
What SCAN looks for
As offerings and interest increase, so do opportunities for home care companies to provide benefits.
Rather than go for one big contract, SCAN prefers to work with smaller, local home care agencies with rates negotiated on an individual basis, Selby said.
“We are certainly not looking to have an advantage at someone else’s expense,” she said of those payment rates. “We know if we want quality and consistency, we have to pay the agency in order for the agency to find the right talent.”
In partnering with new agencies, SCAN prefers those with experience serving seniors. The insurer also looks at company longevity, turnover and training practices, Selby told HHCN.
“Don’t be fearful of the big health plans,” she advises home care agencies. “Don’t wait for them to call you. Certainly reach out.”
Written by Bailey Bryant