HHCN Research: Personal Care Services Projected to Dominate Home Care’s 2020 Medicare Advantage Involvement

The Medicare Advantage (MA) expansions that the Centers for Medicare & Medicaid Services (CMS) announced this year and in early 2018 open the door to creative applications of non-medical home care services designed to proactively improve individuals’ health.

The pair of new rules, with the broader of the two taking effect in 2020, have led to home care industry observers speculating as to just how creative providers might get while working with MA plans.

But based on results from a new Home Health Care News survey, providers of at-home services and supports will use MA plans to deliver on one of their pillar services: personal care.

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Respondents were asked: “Which of the following services do you think MA plans are most interested in covering in the 2020 plan year? Choose up to three.”

The survey, administered last week, asked 105 respondents to choose up to three home care services from a list of seven that they predicted MA plans would be most interested in covering in 2020. Topping the list of responses, by a longshot, was “personal care (bathing, toileting, grooming),” which 84% of respondents selected.

“[With] some of the rules that have been coming out from CMS, there’s obviously an understanding there of the need for unskilled care [or] personal care,” Amedisys Inc. (Nasdaq: AMED) CEO Paul Kusserow told investors this May during the company’s first-quarter earnings call.

While personal care is currently the smallest segment of Amedisys’s massive portfolio, the company plans to drastically expand its offering of those services, which are key to helping seniors age in place, Kusserow noted. And with more than 21,000 employees in 471 facilities spread across 38 states plus Washington, D.C., any comprehensive service expansion that the Baton Rouge, Louisiana-based Amedisys makes will have a significant ripple effect nationwide.

Kusserow credited CMS’s MA rule changes for the planned Amedisys expansion.

“We anticipate there’s going to be more ability for Medicare Advantage plans to be able to fund some of these [personal care services],” Kusserow said on the call.

That sentiment is reflected in the results of the new HHCN survey, with a vast majority of respondents choosing personal care as one of the top three services they see as most attractive to MA plans. That is likely because personal care is increasingly viewed as a lynchpin to improving a senior’s social determinants of health standing.

“I believe [the MA expansion is] a positive step toward expanding the provisions of our services under a value-based payment system,” Addus HomeCare Corporation (Nasdaq: ADUS) President and CEO Dirk Allison told investors in a May earnings call. “We continue to believe that these opportunities will expand as MA plans begin to realize the cost-saving potential of personal care services through a more integrated care delivery model.”

His viewpoint aligns with that of Martin Esquivel, vice president of Medicare product development for Indianapolis-based insurer Anthem Inc. (NYSE: ANTM), who spoke with HHCN in April about the traits Anthem looks for in prospective home care partners in MA plans.

“Data and evidence to support outcomes is always a great way to start the conversation,” Esquivel said.

Based on the HHCN survey results, home care providers believe the data and supportive evidence around outcomes of personal care will be strong enough to entice MA plans to include those services in 2020.

Telehealth high, home modifications low for 2020 MA plans

Looking at the other survey results, the second most popular service for 2020 MA plans is presumed to be telehealth and remote patient monitoring, with 52 votes, or about 50% of respondents. That result tracks with the finalization this year of a set of policies that will expand the use of telehealth benefits under MA.

Finishing third in the survey was “transportation,” at 38% of respondents. “Companionship,” “nutrition support” and “housekeeping” each captured votes in the 20% range. “Home modifications” finished last at 16%.

That last item offers a cold dose of reality on some of the recent enthusiasm around the role that home modifications might play under the new MA landscape. Despite a startling projection from the U.S. Department of Housing and Urban Development that falls will kill 40,000 seniors and cost $60 billion in 2020 alone, home care providers appear to be treading lightly into MA’s reimbursement of home modifications.

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