The Medicare Advantage boom for home care is almost here.
Ever since the Centers for Medicare & Medicaid Services (CMS) first expanded the scope of Medicare Advantage (MA) supplemental benefits in April 2018, at-home care providers have been trying to figure out they fit into a potentially new reimbursement puzzle.
At least initially, it appeared that fit was a relatively minor one, as only 3% of MA plans offered in-home support services such as personal care and housekeeping in 2019, according to AARP statistics.
But a new independent study by actuarial consulting firm Milliman now confirms there will be a substantial expansion in 2020.
Overall, at least 364 plans will take advantage of CMS’s more flexible MA policies in 2020, according to the Milliman study, which was commissioned by the Washington, D.C.-based Better Medicare Alliance. That’s nearly 12% of the 3,148 plans that will be available to Medicare beneficiaries next year.
“The growth in supplemental benefits across Medicare Advantage plans as compared to 2019 tells a remarkable story of how plans are finding new ways to care for the whole person and address social determinants of health,” Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, said in a statement. “These benefits not available in traditional Medicare help enrollees to safely remain in their own homes, avoid social isolation — and lead longer, healthier lives.”
The increased number of plans offering expanded MA supplemental benefits is largely tied to CMS’s updated guidance allowing plans to cover anything that has “a reasonable expectation” of improving or maintaining the well-being of beneficiaries with chronic conditions.
Broadly, Medicare Advantage plans must provide coverage for all benefits covered by fee-for-service Medicare. Without any additional funding, MA plans may also offer other services and supports not covered by traditional Medicare, such as dental, vision and home care.
Family Resource Home Care — a large home care provider with locations across Washington and Idaho — is among the many businesses with sights set on MA. With about 1,000 employees, Family Resource Home Care provides core personal care services focused on activities of daily living (ADLs).
The provider spent much of 2019 educating MA plans about the value of home care while simultaneously building out its data capabilities, CEO Jeff Wiberg previously explained to Home Health Care News.
The new findings from Milliman were “right in-line” with what Wiberg had been expecting for 2020.
“This is exactly what is expected,” he told HHCN on Monday. “I think it will continue to grow as long as those that are partnering with MA plans are dedicated to providing the data needed to help establish the value proposition of our industry on the population the MA plans are trying to manage.”
Although the number of plans offering expanded supplemental benefits is projected to more than triple from 2019 to 2020, the home care industry needs to remember that it’s only in the “early days” of MA, Wiberg said.
Moving forward, plans will continue analyzing the value of home care and its success attracting new MA members and lowering re-hospitalization risk.
“As the data becomes [more] understood, I anticipate that MA plans will continue to expand their offerings to attract subscribers and drive up outcomes for the low-functionality and multi-comorbidity populations,” Wiberg said.
While Family Resource Home Care and other providers may view 2020 with tempered expectations, there are still plenty of positives to take away from the Milliman study. That’s especially true for adult day centers.
At least 64 MA plans will cover adult day health services in 2020, according to Milliman’s research. Historically, no MA plan has ever provided coverage for adult day services.
Besides adult day health services, at least 58 plans will cover home-based palliative care in 2020, while at least 148 plans will cover in-home support services. Additionally, 77 plans will offer benefits aimed at supporting the caregivers of enrollees.
Another 192 plans will cover things like non-opioid pain management, which includes therapeutic massage.
Only 29 plans offered home-based palliative care benefits last year; just 51 offered in-home support services benefits.
“We are encouraged to see progress in 2020 projections for both in-home support services and support for caregivers of enrollees,” FirstLight Home Care CEO Jeff Bevis told HHCN. “Both will help begin to better address the potential impact and improvements from home care services in MA supplemental plans. [But] I still see major room for expansion in the future.”
Of the 354 plans offering expanded supplemental benefits in 2020, at least 116 will offer more than one.
In 2019, there wasn’t a single plan that offered more than one of the benefits Milliman included in its analysis.
The analysis from Milliman is, more than anything, a snapshot. It does not include the full picture of benefits being offered in 2020, researchers noted, as CMS has not yet released all relevant MA data.