What Anthem Wants from Its Medicare Advantage Home Care Partners

Geographic alignment and outside-of-the-box thinking are among the qualities Anthem Inc. (NYSE: ANTM) values from its prospective home care partners in Medicare Advantage (MA) plans.

An ability to demonstrate the value of in-home care services through data and evidence is also important, Martin Esquivel, vice president of Medicare product development for Indianapolis-based Anthem, told Home Health Care News.

“Data and evidence to support outcomes is always a great way to start the conversation,” Esquivel said. “But another good thing to think about is understanding opportunities from a geographic perspective, so homes or facilities align with our service areas, for example.”


Combined, Anthem and its affiliated companies provide coverage for more than 74 million people.

About 3% of all MA enrollees are in plans offered by Anthem affiliates, making the insurer one of the biggest players in the Medicare Advantage market, according to Kaiser Family Foundation statics.

Unlike other major insurers that have taken a slower, wait-and-see approach with expanded MA opportunities focused on in-home services and supports from the Centers for Medicare & Medicaid Services (CMS), Anthem has been quick to strike.


In October, for example, the insurer announced that it was expanding 2019 MA offerings across several of its affiliated health plans through a comprehensive benefits package focused on nutrition, transportation, social isolation and home safety.

CMS initially began changing its policies allow for certain non-medical in-home care services as supplemental benefits under MA plans in April 2018.

“What CMS released in terms of the flexibilities for the 2019 plan year was a very good step for the industry — and I think a good step beyond health plans and into other services provided,” Esquivel said. “We were the first big plan — maybe even the first plan — out the gate in providing services that took advantage of that flexibility CMS offered.”

Branded “Essential Extras” and “Everyday Extras” depending on affiliated health plan, Anthem’s benefits package announced in October included a benefit for up to 124 hours annually of an in-home health aide for respite care, home-based chores and assistance with activities of daily living (ADLs).

The benefits package has been so far successful, according to Esquivel, adding that the insurer has seen an uptick in members signing up as more people become aware of covered services.

“We made the benefit available in a fairly large number of plans, a fairly large number of members,” he said. “When we went to market for 2019, we ended up having a lot of very good conversations with several home care providers. I think we have some interesting paths that we’re on, with the hope and expectation that we’ll find those connections over time.”

At the beginning of this April, CMS further broadened MA supplemental benefit allowances for the 2020 plan year. Next year, MA plans will be able to cover any benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions.

The additional flexibility is “exciting,” Esquivel said.

Anthem will keep building home care bridges moving forward as well.

“What I see out of 2020 is flexibility, certainly,” Esquivel said. “But really the important thing is that it allows health plans — such as Anthem — to address those social and support needs that can impact health.”

Besides the expanded supplemental benefits, CMS recently said it would also allow private MA plans to offer more telehealth services in their basic benefits packages next year.

That too is exciting, according to Esquivel.

“We view telehealth as another way to make it easier for individuals to access care,” he said. “Not everybody has access to cell phones or computers. But a good majority of our beneficiaries do — if not directly, then through loved ones or friends.”

Anne Tumlinson — founder of Washington, D.C.-based research and advisory services firm Anne Tumlinson Innovations — also previously touted the importance of harvesting data and maintaining a basic understanding of insurers’ operations for home care providers interesting in working with MA plans.

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