Home care providers looking to form partnerships with Medicare Advantage (MA) plans will need to leverage the right data to pull the mission off successfully.
The past several years have seen a continued expansion of MA plans.
In 2018, the U.S. Centers for Medicare & Medicaid Services (CMS) issued a final rule that allowed for non-medical in-home care services to become a benefit under MA plans. The following year, CMS widened the scope of this mandate.
More than 750 plans offered home care benefits in 2021. Industry insiders anticipate that the number of MA plans offering these benefits will increase in 2022.
This environment presents a lucrative opportunity for home care providers.
“If providers can capture just 1% of overall MA premiums, that makes home care a $5 billion market,” Maureen O’Connor, senior solutions manager at WellSky, said during a Home Health Care News Medicare Advantage for Home Care Virtual Summit panel discussion.
WellSky is an international software and professional services company with clients that include home health providers, hospital systems, blood banks, labs, hospices, government agencies and human services organizations. The company serves more than 20,000 clients.
In order to lean into these MA opportunities, providers need to identify their core competencies — meaning services their agencies perform better than their competitors.
In general, home care is already positioned to address many of the issues MA plans are currently tackling, including social isolation, access to meals and medication protocol, according to Ali Dean, chief care officer of New Horizons Home Care.
“It’s important to recognize that as home care agencies, our core service offering alone solves some of the biggest problems that MA plans face,” Dean said during the HHCN event. “Unlike insurance companies, we have people who are in the community and in homes that are able to meet clients where they are and address those social determinants of health.”
New Horizons Home Care is one of the largest in-home care agencies in Oregon. The company offers companionship care, housekeeping services, memory care, medication management and skilled nursing services.
For home care providers looking to work with MA plans, technology is another key area of importance.
Providers should be able to bill an MA plan through electronic billing, accept an electronic referral, and, of course, present data.
“Medicare Advantage plans obviously know which members of theirs have been to the hospital — they don’t necessarily know who is also enrolled in, or receives, home care benefits,” O’Connor said. “It’s really on the home care agency to present data to the Medicare Advantage plan [illustrating], ‘These are the patients that we serve that you also serve. While they were under our service, they didn’t go to the hospital, or they had these changes in condition.’”
In addition to data on rehospitalization rate, any data that illustrates how a provider’s presence in the home lowers health care costs is vital in negotiations with MA plans.
“If we can show them that when we’re in the homes, we’re able to reduce by ‘X dollars’ versus us not being there — I think that’s an attention grabber,” Guy Tommasi, managing director of Lifetime Care at Home, said. “They’re going to want to see providers who can demonstrate the ability to reduce costs, maintain satisfaction and keep their enrollees happy. You have to go in knowing those answers.”
Guilford, Connecticut-based Lifetime Care at Home is a non-medical personal care company that offers live-in care, activity assistance, safety monitoring and veteran care.
Ultimately, it’s also important for providers to avoid over-promising and under-delivering when negotiating with MA plans.
“Sometimes in our excitement of having an opportunity to speak to them, we make promises without really knowing if we can fulfill that,” Tommasi said. “We’ve got to have our house in order … because once we get in with them, the expectation is to fulfill what you’ve said. Trust and credibility are going to go hand-in-hand — and that’s where your data will help tell the story.”
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