U.S. home care providers have likely seen the news: 12% of Medicare Advantage (MA) plans will offer some sort of expanded supplemental benefits in 2020. But while some agencies are enthusiastic about the expansion and preparing for a competitive MA landgrab next year, others are saying “not so fast.”
At least 364 MA plans will offer innovative supplemental benefits that draw on federal policymakers’ more flexible rulemaking for 2020, according to a recent study from actuarial consulting firm Milliman and the Better Medicare Alliance.
Of those, at least 64 will cover adult day health services and at least 148 will cover in-home support services, perhaps the most exciting benefits area for home care providers.
Based on those numbers, that means roughly 12% of MA plans are getting creative for 2020 and will be open for home care business. That’s a big difference than in 2019 when just 3% of plans offered things like in-home support services.
Still, it’s a far cry from universal adoption.
“Although there are three times more plans covering for in-home support services in 2020 compared to 2019, we were hopeful for a larger increase because we know the impact of chronically ill individuals in reducing costs and improving incomes,” Jennifer Ramona, vice president of strategy and health care innovation at Homewatch CareGivers, told Home Health Care News.
Denver-based Homewatch CareGivers — acquired as part of London-based Apax Partners’ acquisition of Authority Brands in 2018 — provides in-home care services across 31 U.S. states and a total of seven countries. As of April 2019, the company had 198 franchise owners in its network.
Homewatch CareGivers has been one of the more active providers in going after Medicare Advantage opportunities, even creating a new internal position to support its offices in pursuing MA business.
Although Homewatch CareGivers may have been hoping for a bigger MA expansion in 2020, it still plans on maintaining its ongoing strategy, Ramona noted.
“This reinforces that we’ll stay on track with our MA strategy, which is to continue to partner with MA organizations at both the local and national levels,” she said.
Omaha, Nebraska-based Right at Home is also among the more active home care providers when it comes to MA. Right at Home — a branch of RiseMark Holdings LLC — has more than 400 domestic franchise locations and another 100 or so outside the U.S.
Doug Robertson, the in-home care franchise company’s health care regulation and compliance manager, called the recent study from Milliman and the Better Medicare Alliance “interesting,” but noted that there’s room for growth, especially when it comes to in-home support services.
“As a home care provider, we are specifically interested in plans that offer in-home support services,” he told HHCN. “Based on [available data], in 2019, 51 — or 1.8% — of all plans included those benefits. In 2020, the number grew 4.7%, a modest increase from 2019 but still a small number of plans, as insurance carriers really don’t have any more usage data than they had last year.”
On top of the sheer number of MA plans doing in-home care, the ones that do typically keep utilization relatively low.
“Even if the reimbursement is par, the number of hours annually is still low,” Robertson said. “We have not heard of a plan offering more than 124 hours of care annually.”
Furthermore, the uptick in MA plans expanding supplemental benefits in 2020 could be slightly misleading, he pointed out. It’s often the large plans — like Anthem, for example — that already have skin in the game that contribute to the 2020 figures.
“Anthem expanded their home care benefit to many more plans in more states, so most of the increase in percentage is likely attributable to that carrier, which was an early adopter of the new benefits,” Robertson said.
HHCN highlighted Anthem’s MA agenda in October.