Newfound Medicare Advantage (MA) flexibilities have encouraged many of the big U.S. insurers to pursue tighter relationships with home- and community-based care providers for the 2020 plan year.
But up-and-coming MA players are doing the same, including the still large but slightly lesser-known senior-focused health services company Alignment Healthcare.
Alignment revealed several new socially conscious, home-centric offerings for its 2020 members in early October. The Orange, California-based company on Thursday also announced it would cover in-home primary care services provided by house-call startup Heal.
Broadly, both moves are part of Alignment’s overarching strategy of supporting whole-person care and understanding what’s going on in members’ homes, Consumer President Dawn Maroney told Home Health Care News.
“In many instances, you can go into the home and see things such as food security, whether there’s depression, whether somebody lives alone or lacks access to transportation,” Maroney said. “Making sure seniors get the care they need isn’t just about the care itself. It’s about taking care of their well-being and that individual as a person.”
The privately held Alignment — which has deep ties to federal health care decisionmakers from both ends of the aisle — currently offers plans in California, North Carolina and Florida.
Former Centers for Medicare & Medicaid Services (CMS) administrators Andy Slavitt and Dr. Mark McClellan both serve as managing directors for Alignment.
Starting on Jan. 1, 2020, Alignment is doubling its California footprint into eight additional counties, where more than 862,000 Medicare beneficiaries live.
“California is obviously one of the largest states for Medicare Advantage,” Maroney said. “So we’re excited about that.”
For the 12-month period ending June 30, Alignment reported revenues of $703.5 million, with company executives saying the $1 billion mark is not far off.
Groceries and grandkids on-demand
Alignment Healthcare was founded in 2013 after CEO and founder John Kao struggled to find high-quality and coordinated care for his mother.
Its 2020 plans build on that legacy and the core benefits Alignment already provides, such as around-the-clock personal concierge services.
Specifically, Alignment’s 2020 plan choices will include, for example, a monthly grocery allowance as well as transportation services provided by ride-hailing giants Uber and Lyft.
To tackle the rising loneliness epidemic among older adults, Alignment will also offer a “grandkids-on-demand” benefit by teaming up with Miami-based startup Papa
Alignment is largely able to expand its 2020 offerings because of updated MA rules unveiled by CMS in April.
Next year, MA plans are able to offer any supplemental benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions.
“We’ve been doing a lot of this for many years now,” Maroney said. “What I love about what CMS is doing is that they’re now pushing this in the environment with every Medicare Advantage contract across the country. So we’re seeing a lot of phenomenal innovation.”
As part of its business model, Papa connects college students with older adults who need assistance with non-medical services — light housekeeping, technology support and general companionship. Alignment will cover Papa’s services for members for up to two hours per day.
Papa is coming off a fresh $10 million Series A fundraising round, with investment led by Silicon Valley-area venture capital firm Canaan. Besides Alignment, Humana (NYSE: HUM), Aetna and Priority Health have also highlighted their relationships with Papa.
Doctor house calls
Los Angles-based Heal — a company that does doctor house calls — has likewise entered into Alignment’s plans.
Alignment members in select cities throughout Los Angeles and Orange Counties will now be able to select Heal doctors for primary care. Through Heal, members will be able to book appointments within a two-hour window and use the Heal Hub for remote monitoring in the home.
Currently, Heal has more than 100 doctors in its network, most of whom work on a full-time basis. In 2019 alone, the company will have completed 100,000 house calls, averaging an estimated $53.7 million per year in overall health care cost savings.
The startup recently expanded into the New York market by acquiring Doctors on Call. It also delivers house call across California, Atlanta, Washington, D.C, and northern Virginia.
Heal has been shown to reduce client hospitalization rates by nearly 30%.
While in the home, Heal doctors can help assess Alignment members’ home environments and social determinants of health while also reviewing medications and evaluating general physical health.
“Together with Alignment Healthcare, we can deliver the best end-to-end health care experience available anywhere,” Nick Desai, co-founder and CEO of Heal, told HHCN in an email. “Alignment’s innovative plan designs and value-added features marry perfectly with Heal’s data-driven, unhurried house calls for health care that drives improved outcomes, high patient satisfaction and meaningfully lower health care costs.”