States with the Most ‘Primarily Health-Related’ Medicare Advantage Opportunities for Home Care Agencies

With hundreds of plans reportedly offering in-home support services in 2021, the coming year is certain to bring more Medicare Advantage (MA) opportunities for home care agencies.

But some home care operators will have more opportunities than others due to geographic variability across the MA landscape. To find leads, agency leaders will need to understand what’s going on in their market and identify plans to go after.

“We’re seeing a few states sort of rise to the top, with a number of plans offering in-home supports under Medicare Advantage,” Tyler Cromer, a principal at Washington, D.C.-based research and advisory firm ATI Advisory, told Home Health Care News.

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To help home care operators with their MA strategies, ATI Advisory recently released its 2021 Medicare Advantage Supplemental Benefits State Report. Broadly, the report maps out where MA plans are operating while highlighting the supplemental benefits they’ll offer next year, including in-home support services.

It currently focuses on the 738 plans that will offer “primarily health-related” supplemental benefits in 2021.

“After going through this research process a few times with different organizations last year, we decided, this year, we’re going to package all the data up and put it on our website,” ATI Advisory CEO Anne Tumlinson told HHCN. “We learned that it’s actually kind of challenging for individual agencies and even corporate leadership to navigate government data this way. That’s our expertise.”

While the report comes at a cost, ATI Advisory shared key state-level takeaways with HHCN.

Of the 738 plans offering primarily health-related supplemental benefits next year, 429 will offer in-home support services, doing so across 36 states and Puerto Rico. Florida and California will have the most plans offering in-home support services in 2021, with 103 and 57, respectively.

“There are probably no surprises there, given the size of their population,” Cromer said. “And each has a lot of Medicare Advantage plans.”

Texas, Michigan and Ohio round out the top-five states for in-home support services, with 36, 31 and 24 plans offering in-home support services.

Meanwhile, in-home support services are newly available in six states in 2021, ATI Advisory data shows. Those states are Alabama, Iowa, Minnesota, Nevada, Oklahoma and Utah.

In terms of carriers, Anthem Inc. (NYSE: ANTM) and Centene are the leaders in the space, with each offering in-home support services and other expanded primarily health-related benefits in over 100 plans. Generally, 14% of all Medicare Advantage organizations will offer in-home support services in at least one of their plans next year.

“We’re actually seeing just more coverage of in-home support services geographically, across the country,” Cromer said. “We’re seeing real growth in this space, particularly around in-home support.”

When it comes to hunting for MA opportunities, home care operators need to take a two-pronged approach.

First, Tumlinson said, they must look internally to identify their value — and how they measure it.

“Do you have a digital platform for collecting information? Do you have electronic visit verification? What kind of data do you have on your employees? What can you say about your quality?” she said. “You want to look at all of those things and what makes you a strong operator relative to your competition.”

While looking inward, home care leaders must also conduct their own market intelligence to figure out the MA plans they want to appeal to.

Then, it’s all about shaping an agency’s Medicare Advantage pitch. If an MA plan is interested in working with an agency, it will then assist with final steps like credentialing and more.

“Once you’re in a conversation with a plan about how to be part of their network of providers, either they or some other third-party intermediary will assist with making sure that you’re a credentialed provider for the purposes of being in-network, that you’re set up to submit claims and things like that,” Tumlinson said. “Those pieces are hard, but they’re all problems you can solve.”

“The relationship is the hardest part,” she added.

Updated data from the Centers for Medicare & Medicaid Services (CMS) shows that MA penetration has reached 40% of the total Medicare-eligible population for the first time in history. There were about 25.4 million MA beneficiaries nationwide for the month of October, with a total Medicare-eligible population of 62.4 million.

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