Better Medicare Alliance CEO: Integrating Home Care into Medicare Advantage Easier Said Than Done

For more than a year now, home care has taken center stage in the discussion surrounding Medicare Advantage (MA). Things were no different at last month’s MA Summit, hosted by the Better Medicare Alliance (BMA) in Washington, D.C.

There, health care leaders from a variety of sectors and legislators from both sides of the aisle came together to discuss MA trends. One resounding takeaway was the importance of home care — and the struggle to successfully integrate it into MA plans.

In between sessions, HHCN sat down with BMA President and CEO Allyson Schwartz, who shared her views on how home care has forever changed the MA game. Schwartz, a Democrat, is also a former member of the United States House of Representatives.

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You can find HHCN’s conversation with Schwartz below, edited for length and clarity.

First of all, as the organizer of this event, what are some of the key takeaways from the discussions going on here — or even just from the past year as it relates to MA? 

One of the very significant changes that has been made in the past year or two is this redefinition and expansion of the kinds of supplemental benefits that can be provided — and that they can actually be targeted to a population particularly in need.

That is a game changer for Medicare Advantage and the Medicare beneficiaries they serve.

We’re excited about the opportunities to address social determinants through some of these new flexibilities. We’re hearing [about] the keen interest in transportation to appointments, for example. Then, we also hear about nutrition and meals as being important, as well as care in the home.

You heard about that [already,] particularly from the president and CEO of Humana, [Bruce Broussard,] talking about care in the home, … not just [following] post-acute stays, but to actually be able to prevent those hospitalizations and to support [member] health.

In 2019, plans were slow to adopt these in-home care supplemental benefits. What do you think needs to happen to speed up that process and result in a wider rollout of in-home care benefits?

For 2019, the timing was difficult. The announcement of these changes happened about five weeks before the bids were due. So there’s background work to do in making decisions about these supplemental [benefits].

There were no additional funds for these services. People think, ‘Oh, they must have gotten funding for all of these new supplemental benefits.’ They did not. The plans will still be getting the payments they would have gotten anyway.

They do have to make decisions … about which services they think they could afford to provide.

Do they have to reduce some other services in order to do that? Or, in fact, do they believe that the return on investment would be significant enough to move ahead on these additional benefits?

A number of these benefits are targeted to people with chronic conditions, so these are not universal necessarily. They are ones you get a referral to if you have a chronic condition that warrants it.

[Plans] have to figure those populations out, how they’re going to target them and, of course, how they’re going to afford to do it within the payment they already receive from CMS.

What are you hearing or expecting to see in 2020?

We do think there will be more [supplemental benefit offerings].

Plus, the rule changed slightly. There were some changes made for 2019, [but] more made for 2020 because of the Chronic Care Act.

We do expect to see more [in-home care supplemental benefits]. We won’t know until everybody else knows, when the plans announce their bids. Some [plans] will also look for approval from CMS for each of these.

I believe it’s going to take a couple years to see the kind of expansion many of us hope for, but in that process, plans will … explore some of these options.

What advice would you have for any home-based care providers interested in working with a plan? How do they go about doing that, and is there any advice you would have regarding how they could sell themselves or make themselves attractive partners?

One of the issues will be the plans offering these benefits — and then providers knowing about it and getting used to the referral or use of the supplemental [benefit].

That, again, is a process.

There are a couple different ways to [sell yourself to plans].

Some of this is quite local, so it really means getting to know someone at your plan, presenting yourself, knowing how to bid (if they bid it out) or how to create a proposal. It’s really being an entrepreneur.

For a lot of home care providers [that] get the money that they get and the reimbursement that they get under public funding … this is a different process.

It takes certain negotiation and building relationships. I know that a number of the associations are trying to provide some technical support in this.

It’s really about marketing your services in order to work it out, mostly at the plan-level. Once the plan broadly has agreed to do it, it’s more at the local level that some of this happens.

Is there anything you’re excited about that we haven’t touched on yet?

I think the interesting part of home care services is that there’s a broad spectrum of what home care services are.

There’s also the question of how do you provide those services and how do you maintain a relationship with the primary care providers? It’s not a total handoff. It’s supposed to be more integrated than that. That’s a bit new as well for home care providers

During his keynote, Broussard suggested MA could be the starting point for a wider Medicare-for-All sort of program. Then, of course, we heard from Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, who had a very different take. Where do you stand?

We do believe that Medicare Advantage is an important model [and] that the opportunity to move from a sole fee-for-service model to a value-based integrated care model that can attend to these additional needs is really … important in Medicare in particular.

It’s a model that could improve care more broadly. How that gets done is open to further conversation, but we have been very careful to not take a position directly on some of the [Medicare-for-All] proposals, and we, of course, would not have gone where the administrator went.

From our point of view, Medicare Advantage and the model it creates should be a part of the future of Medicare, whatever happens.

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