Partly due to a lack of funds and existing data, Medicare Advantage (MA) plans have been slow to roll out home care-focused supplemental benefits now allowed under Centers for Medicare & Medicaid Services (CMS) guidelines. Even so, many home care companies hoping to become MA partners have launched targeted campaigns to win plans’ attention.
Among these companies is BrightStar Care, a Chicago-based in-home care franchise that offers medical care, non-medical care and medical staffing. BrightStar has more than 330 locations across the U.S. and Canada.
With the expansion of in-home services and supports under MA, plans will value home care providers that can help them meet their objectives of including effective supplemental benefits in plan design, according to BrightStar Care Chief Technology Officer James Kearns.
That means supplemental benefits that simultaneously reduce the total cost of care for specific conditions and help differentiate MA plans in a competitive marketplace dominated by a handful of major players.
“We believe the forward-thinking Medicare Advantage plans will want partners with proven track records of ensuring quality care, as validated by accreditation and outcomes data,” Kearns told Home Health Care News.
Additionally, according to Kearns, MA plans will look for partners that provide quality, coordinated in-home supportive services, including respite care and palliative care, in particular.
In its experience, BrightStar Care has also noticed that MA plans are looking for partners dedicated to improving staff competency and increasing staff retention, as poor turnaround could lead to inconsistent service delivery. Similarly, plans are seeking home care partners with a reputation of proper utilization — or not providing more services than are necessary.
In April 2018, CMS announced that it would include non-medical in-home care as a supplemental benefit for 2019 MA plans. This April, CMS announced that MA plans in 2020 could cover any in-home care services and supports that realistically improve the health of individuals with chronic conditions.
At the start of 2019, only 3% of MA plans opted to offer in-home support services, according to AARP.
One of the major roadblocks has been money, as MA plans are mostly working with the same budget they had prior to the two expansions.
For providers hoping to roll out an MA engagement plan, participation in pilots may be key, Kearns said.
Most MA plans will look to do pilots as a way to gain more experience in deploying personal care benefits and obtaining data on outcomes and costs.
“Personal Care providers should be leveraging existing relationships to find opportunities to participate in early trials, and position themselves for future commercial opportunities as MA plans broaden the reach of these programs,” he said.
As for BrightStar Care, the company is closely monitoring the MA opportunity and will be participating in pilots throughout the rest of 2019. It is not contracting with any plans at the moment, Kearns said, though it has “had discussions with several of them.”
“Our 2020 plans will depend a lot on what we find out on how many plans will be adding the benefit[s] in 2020,” Kearns said.
Lifesprk, Right at Home, 24 Hour Home Care, Homewatch CareGivers and several other home-based care providers have likewise been vocal about their MA intentions. Many industry leaders expect the real home care MA opportunity to emerge in 2020.
“We want to be engaged with the MA plans early in order to help inform the expectations of a home care partner to be able to demonstrate value to the plan and their enrollees, and in return for home care providers to be able to expect fair requirements and reimbursements from the plans,” Jennifer Ramona, vice president of strategy and health care innovation at the Denver-based franchisor Homewatch CareGivers, told HHCN in April. “We are not waiting for 2021.”
Apart from MA, Kearns has been busy on the technology front for BrightStar Care.
“We have a few [technology initiatives] that we are not ready to announce, but much of our focus has been on completing our automation initiatives,” he said.
In 2017, BrightStar Care rolled out its automated personal care services, which included electronic time and attendance, clinical assessments, plans of care and care notes. To date, the provider has more than 1 million documented care visits.
Meanwhile, in 2019, BrightStar Care also began the rollout of its automation initiative for skilled services offerings, which includes electronic physician orders management, clinical assessments, plans of care, clinical documentation for infusions, medical set-ups, wound care, skilled nursing and more.