With SCAN Health Plan and CareMore contracts, 24 Hour Home Care has been among the most active non-medical home care providers when it comes to 2019’s expanded Medicare Advantage (MA) benefits.
Its early success working with MA players serves as a case study for industry peers looking to do the same in 2020 and beyond.
Los Angeles-based 24 Hour Home Care — formerly branded as 24Hr HomeCare — provides professional caregiving services to older adults and individuals with developmental disabilities across California, Arizona and the Dallas metropolitan areas. With a reputation as a high-quality home care provider and a history of taking care of the chronically ill, 24 Hour Home Care got its foot in the MA door shortly after the Centers for Medicare & Medicaid Services (CMS) first signaled its intent to make the MA program more flexible in February 2018.
“It was probably in February 2018 when we first connected with [SCAN Health Plan],” Gavin Ward, regional director of strategy and partnership for 24 Hour Home Care, told Home Health Care News. “I’ve known the folks at SCAN for many years. I gave [them] a quick call, left a message that we had experience working with at-risk populations and thought there could be some synergy.”
After floating the idea of expanding Medicare Advantage to include certain non-medical services and supports in February, CMS finalized the plan in April 2018. The agency doubled down on its MA expansion in 2019 as well, announcing this April it would allow plans to cover any benefits with “a reasonable expectation of improving or maintaining the health or overall function” of chronically ill members during the 2020 plan year.
Today, 24 Hour Home Care and SCAN Health Plan are teaming up through a program dubbed “Returning to Home.”
Broadly, Returning to Home is a post-hospitalization initiative for SCAN’s MA members aimed at preventing readmissions and solidifying the discharge process. The goal of the 30-day benefit is to allow SCAN members to “get back to their baseline” and safely recover in their private homes, Lisa Roth, vice president of care coordination at SCAN Health Plan, told HHCN.
“We provide eligible members with in-home personal care and homemaking services that we have contracted with 24 Hour Home Care on,” Roth said. “We also provide home-delivered meals. A lot of times, individuals are discharged from the hospital and may not be prepared with everything lined up at home.”
Founded in 1977, Long Beach, California-based SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in the Golden State. Apart from Returning to Home, the plan has its “Home Advantage” program, which helps bring an occupational therapist into the homes of its members for a safety check.
While some say data and scale are the keys for home care providers to land MA relationships, the mission-driven SCAN values proven expertise, according to Roth.
“To me, it’s all about reputation and having that know-how of working with seniors, knowing about the challenges they face,” she said. “When you have somebody who is at risk, they’re likely just coming home from the hospital, at their weakest and most vulnerable. To have somebody actually come into their home and help them undress, shower or with toileting, there has to be a great deal of sensitivity and trust.”
Connecting with CareMore
In a recent HHCN survey of 105 providers of at-home services and supports, 59% of them reported contracting with an MA plan for the 2019 plan year. Of the 105, 90% anticipate working with plans in 2020.
In addition to contracting with SCAN Health Plan, 24 Hour Home Care also is working with CareMore Health, an integrated health care delivery system for Medicare and Medicaid patients. A subsidiary of Indianapolis-based Anthem Inc. (NYSE: ANTM), CareMore serves more than 150,000 patients across nine states and the District of Columbia.
“CareMore was very happy to receive the [April 2018 MA guidance from CMS] and immediately saw an opportunity to help engage its patients with new benefits that were not allowed previously,” Scott Rinefort, senior director of product design for CareMore, told HHCN. “We reached out to 24 Hour Home Care and found a partner that can help us with the provision of these evolving home care benefits.”
By contracting with 24 Hour Home Care, CareMore now covers 40 hours per year of respite care at no out-of-pocket costs for patients, Rinefort said. Similar to SCAN, CareMore is also teaming up with 24 Hour Home Care on a benefit focused on the post-discharge process.
“In order to help these patients get back home and get back on their feet in the friendly confines of their own home, we provide four total four-hour shifts — so 16 hours overall — of services through the staff of 24 Hour Home Care,” he said. “Just to help them recover.”
Services are wide-ranging and include everything from help with cooking and dressing to assistance with housekeeping. CareMore additionally offers a program — branded as the Togetherness Program — that targets isolation.
“We picked 24 Hour Home Care for three main reasons: flexibility, geographic coverage and company cultures,” Rinefort said. “We seek out to find partners more than vendors that can work with us in a collaborative fashion to design deliverable, pragmatic solutions.”
It’s too early to say exactly how the new benefits delivered by 24 Hour Home Care have benefited CareMore’s MA plan members, he noted.
The Social HMO demo
For SCAN, offering in-home care services and supports is nothing new.
The health plan was originally one of the four participants in CMS’s Social HMO Demonstration that took place in the 80s and 90s. Others included Elderplan in New York, Kaiser Permanente’s Senior Advantage II in Oregon and Senior Plus in Minnesota.
Known as SHMO, the goal of the demo was to expand coverage of community and nursing home care in a controlled manner while better linking those services to the acute care system.
Although promising, the SHMO demo — funded by a mix of Medicare, beneficiary premiums and Medicaid funds — never really caught on. For example, CMS’s initial enrollment target for the demo was, 4,000 members per participating site within 12 to 18 months after launch. Actual enrollment during that time ranged from 433 to 3,174 enrollees, with no participants hitting the target.
As a result, the SHMO demonstration was sunsetted, Roth said. Still, participation in the test gave SCAN a head start on covering home care benefits tied to CMS’s Medicare Advantage expansion.
“We were providing a full array of personal care and homemaking, home-delivered meals, adult day health care, incontinence supplies,” she said. “We all know that social determinants of health is the new buzz word. It’s the new thing. But it’s something we’ve actually been doing for over 40 years now.”
So far, 24 Hour Home Care has learned several lessons from its experiences working with SCAN and CareMore, Ward said. Among them: the importance of business intelligence capabilities, especially those that help measure client and caregiver satisfaction.
“24 Hour Home Care has invested a lot into business intelligence,” Ward said. “It is quite an investment, but I think we now have tools that can capture our patient population with regard to utilization and length of stay, client experience and feedback.”
“I think our industry as a whole has struggled or not invested enough in tools that capture both client and caregiver satisfaction,” he added.
So far, providing MA-covered benefits hasn’t had a huge impact on 24 Hour Home Care’s bottom line, according to Ward. That’s not surprising, as home health providers have often highlighted the relatively lower reimbursement rates they receive under MA compared to Medicare fee-for-service.
In reality, home care executives should think about Medicare Advantage’s impact on a more long-term basis. As more home care services are covered by MA and access is increased, greater numbers of older adults will likely turn to local providers for support.
“I’ll speak bluntly. I think if a home care agency is thinking that … signing up for Medicare Advantage partnerships is going to make them wealthy, they may want to reconsider,” Ward said. “This is an opportunity for us to make history with a population where there’s not a lot of data on outcomes. I don’t think the insurance plans … are going to open up the floodgates and provide authorizations for 24/7 care.”