Prior to the onset of the COVID-19 crisis, the Medicare Advantage (MA) landscape looked like a promising business opportunity for in-home care providers. That was, in part, thanks to two major expansions of MA supplemental benefits in 2018 and 2019.
But the U.S. is now more than a month removed from a coronavirus public health emergency being declared. And similar to everything else in health care, a lot has changed in the MA space.
The way insurance plans operate has been altered. The way their members carry out their regular, day-to-day lives has been upended.
For home care providers, the impact that the coronavirus has had on MA could ultimately mean more opportunity in 2021. Yet it could also mean less. Either way, the virus means home care operators will need to sift through even more unknowns to develop their MA strategies moving forward.
“For the last couple years, the trends related to Medicare Advantage have been strong,” Matt Kazan, principal at Avalere Health, told Home Health Care News. “Congress and the Centers for Medicare & Medicaid Services (CMS) have seemed to err on the side of providing plans with greater flexibility.”
Washington, D.C.-based Avalere Health is a health care research and consulting firm. Prior to Kazan’s time at Avalere, he was a senior health policy advisor on the Senate’s Committee on Finance, where one of his main focuses was MA.
“I think COVID-19, obviously, presents challenges for the entire health care system — and MA is not unique there,” Kazan said.
Specifically, there are questions related to the Special Supplemental Benefits for the Chronically Ill (SSBCI) program, one of the two major MA expansions over the past few years.
Announced in 2019 for the 2020 plan year, SSBCI allows MA plans to cover home-focused services like non-medical transportation, meal support, home modification and other “general supports for living” for certain populations. As of March, there were at least 245 plans offering one or more of the SSBCI options, according to ATI Advisory.
A new door
With its focus on social determinants of health and the chronically ill, SSBCI promptly opened a new door for home care providers.
And in months to come, the MA program could be a vital tool for keeping chronically ill seniors healthy during the COVID-19 crisis. With the at-risk population expanding due to the threat of the COVID-19 virus, mitigating hospital visits and unnecessary trips outside the home will be more important than ever.
Currently, SSBCI services are offered to patients that have at least one of 45 specified chronic conditions. CMS has proposed expanding that list for 2021, with some MA experts predicting the inclusion of new COVID-19-related conditions.
Additionally, beyond adding to that list of 45 conditions, some believe CMS could also open up SSBCI for MA enrollees more broadly, perhaps expanding it to more than just the chronically ill.
If either — or both — of those adjustments are made to SSBCI eligibility requirements, it could mean a lot more potential MA enrollees for home care agencies to serve.
“CMS has proposed to expand the list of enrollees who could get these types of supplemental benefits to basically anyone who’s at risk of a hospitalization or has a life-threatening disease,” Kazan said. “Clearly, that would include patients with COVID-19. … So, I think that’s one issue to watch for, in terms of kind of an expansion of this supplemental benefit population and kind of the intersection with COVID-19.”
According to Kaiser Family Foundation statistics, nearly 20 million Americans had enrolled in MA as of 2018, almost double the number enrolled in 2010.
Typically, MA benefits are set in June for the following year. Assuming the coronavirus is still at the forefront of health care concerns in two months, 2021’s MA environment will likely reflect ongoing priorities.
“What is 2021 going to look like in terms of utilization and COVID-19?” Kazan said. “We know that there are certain communities and certain patients who have difficulties generally accessing nutritious food, transportation and feel the effects of social isolation — all of those get exacerbated with COVID-19. Plans do have an opportunity to try to show how this flexibility could benefit in ways that we hadn’t thought about several years ago.”
Likewise, home care providers have an opportunity to flex their muscles and show how they can contribute to the mitigation of COVID-19, without necessarily treating patients who have been infected.
Regardless of how the COVID-19 crisis affects insurers in the future, the increased attention paid to SSBCI and home care services is obvious — and that attention has led to robust demand.
Cincinnati-based home care franchise company FirstLight Home Care has been among the home care providers scrambling to accelerate their MA involvement, its founder and CEO, Jeff Bevis, told HHCN.
“We’re more on the acceleration side,” Bevis said. “We’re just trying to actually gear up even faster now.”
With locations in more than 30 states overall, FirstLight was already active in MA across the country, having contracted with two large MA plans in the year leading up to COVID-19. Multiple of the seven states that those contracts cover have thus far exceeded FirstLight’s expectations in terms of referrals and utilization, Bevis said.
“We are seeing even more referral flow coming from [the states we’re operating in] and we have some additional plans that are pending to be finalized and approved as well,” Bevis said. “We think [MA] is going to be accelerating and become even a bigger opportunity.”
FirstLight, like other home care companies, had been bullish on MA — and SSBCI, in particular — for a while. But the franchiser has been presented with new issues and opportunities to consider over the past month or two.
“The primary one for us has been personal care services — the one we picked up with Medicare Advantage supplement benefit plans starting in 2019,” Bevis said. “But some of these new plans and added contracts that [we’ve partnered with] in the last 90 to 120 days — pre-crisis — have asked us to focus on some other, more disease-specific services.”
That has given FirstLight reason to believe it can expand the services it provides to MA beneficiaries around the country.
“I do think that the COVID-19 crisis has put home care even more front and center, especially as it relates to Medicare Advantage benefits,” Bevis said. “And I do think it’s going to be kind of a wind at our backs to probably add more services under Medicare sooner versus later.”
Kerin Zuger, chief of strategic growth for Right at Home, agreed. Omaha, Nebraska-based Right at Home is a home care franchise company with more than 500 locations across the U.S.
“For many seniors, home care continues to be an attractive care setting, particularly considering the spread of Coronavirus in institutional settings — so the MA opportunity will continue to be there,” Zuger told HHCN in an email. “Many in the industry believe there will be a lasting uptick in seniors seeking to stay at home because of the COVID-19 infection and fatality rates among seniors.”
Right at Home continues to service Medicare Advantage members during the coronavirus emergency and is reviewing “significant expansion opportunities for 2021,” she noted.
Home-focused companies proving their worth
Most home care operators assumed that the adoption of expanded MA benefits would be a multi-year process, but the presence of the coronavirus does have the potential to speed things up.
The companies that have made strong partnerships in the field, even outside of traditional home care, are welcoming the increased interest in non-medical care and social determinants of health.
Like FirstLight, Papa Inc., a Miami-based company that provides companionship and wide-ranging assistance to seniors, has also seen a bump in interest for its services, CEO Andrew Parker told HHCN.
“It’s been pretty significant for us,” Parker said. “Both our [current] health plan partners and new health plans have been reaching out to us to offer Papa as a benefit to their members.”
Papa’s non-medical capabilities are in line with SSBCI offerings and are similarly well-suited to deal with COVID-19 challenges, like seniors being isolated in their homes.
Normally, Papa offers an in-person service that pairs “Papa Pals” with seniors, while also offerings support for technology assistance, transportation and light housework. The company is still providing over 1,000 visits per day, though many services are now only delivered virtually.
“We’re able to get members groceries, medicine and much more,” Parker said. “We’re [continuing] to partner with organizations — especially with the health plans that already have some services, but need to be able to get specific benefits to their members and are leveraging Papa to do so.”
It’s never a bad time to prove your worth. And for providers aiming to be a part of the solution to the spread of the coronavirus, the ever-changing MA world is serving as an outlet to do just that — with an increase in business along the way.