How One Home Care Provider Earned 30% Rate Increases From MA Plans

More than ever, Medicare Advantage (MA) plans are stepping up and responding to the demand for more access to care in the home setting. This, in turn, has created an avenue for home-based care providers to lean into new opportunities.

Over the past couple of years, the amount of MA plans offering care services in the home has increased significantly.

Currently, 729 MA plans are offering in-home support services, compared to just 223 in 2020. Additionally, 147 plans are offering home-based palliative care in 2022, compared to only 61 in 2020, according to data from the ATI Advisory.


Companies such as Anthem Inc. (NYSE: ANTM), Centene Corporation (NYSE: CNC), Humana Inc. (NYSE: HUM) and SCAN Group are responsible for the plans that are offering the most in-home support services.

But access to at-home care services should not be viewed as just the cherry on top, according to Mary Beth Donahue, the president and CEO of Better Medicare Alliance (BMA).

“It’s very important to understand that these are not simply perks, or extras for many older adults on Medicare Advantage,” she said during a BMA and Moving Health Home (MHH) virtual event on Thursday. “These at-home benefits are a lifeline, enabling them to age-in-place, manage disease progression and live with dignity and independence.”


One company, Signify Health (NYSE: SGFY), is partnering with MA plans to deliver in-home care.

“We at Signify provide about 2 million in-home evaluations for the MA population,” Dr. Damien Doyle, vice president of medical affairs, home & community services at Signify, said during the event.

Dallas-based Signify is a tech-enabled, value-based care platform that partners with both health plans and health systems to deliver a variety of care services to patients in their homes.

Doyle referred to Signify’s utilization of its in-home evaluations as “invaluable.”

“During those in-home visits, we’re able to discern the unique challenges that beneficiaries are encountering,” he said. “Our partners, primarily MA plans and health systems, use this information to better tailor their services to their members.”

For example, if it’s determined that medication is an issue, the health and primary care team will look for solutions, such as shifting to mail order to avoid making the beneficiary have to travel to the pharmacy, Doyle noted.

When it comes to explaining the home-based care value proposition to MA plans, data has been the main tool of choice for BrightStar Care.

“The rates were unsustainable from the very beginning — they’re low — so we believed we needed to have data to show how home care can really reduce the overall cost of care,” BrightStar Care CEO said.

Chicago-based BrightStar Care is a home care and medical staffing franchise with more than 365 locations nationwide. The company provides medical and non-medical services to clients in their homes, as well as supplemental care staff to corporate clients.

BrightStar Care entered a partnership with Avalere Health in order to leverage the health care consulting firm’s access to Medicare part A and B claims data. BrightStar Care put this data up against its own population to demonstrate how they were lowering the overall cost of care.

“We had to be able to tell the story, backed up by data, as to how we improve results,” Sun said.

Specifically, the total cost of care for BrightStar Care clients was $30,000 lower compared to other Medicare patients.

“We’ve been very successful in being able to have our Medicare Advantage plans see our quality compared to others, and our outcomes compared to others, and we use our Avalere data to get that conversation started,” Sun said. “[BrightStar Care has] been able to get over 30%rate increases, as we’ve had some of the plans be able to see our data compared to others.”

Still, roadblocks exist around larger adoption of care in the home in the MA market.

One of these barriers is the lack of standardization across home care, Home Care Association of America CEO Vicki Hoak said.

“We have a bit of an identity crisis,” she said. “We’re dealing with this because we have no national standard right now for in-home support care. Only 30 states license in-home support care.”

In other words, when MA plans want to know a provider’s standards of care, the answer isn’t consistent across all of the states a provider operates in.

“The fact that we have to pause for a minute and say, ‘Okay, you’re in Illinois, this is what we’re permitted to do [here], you’re in California,’” Hoak said. “That in itself becomes a barrier.”

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