The convener platform healthAlign has a front-row seat to see how home care is being utilized in Medicare Advantage (MA).
Andy Friedell, the company’s founder and CEO, has always been bullish on home care’s growing prevalence in MA, even when providers began to shy away from it a bit after initial excitement over supplemental-benefit updates in 2018 and 2019.
“We have pretty good insight into what you see take place over a period of time when these public policy changes occur,” Friedell said at HHCN’s Home Care Conference last December. “And to us, while this was a seemingly small change in the Medicare regulations, allowing more flexibility for MA plans to offer some of these services at home … can create a huge shift over time.”
The Annapolis, Maryland-based healthAlign is a convener of home-based care services. It operates a platform that makes the delivery of services more seamless when at-home care entities and health plans are working together.
Medicaid was originally healthAlign’s focus, but that eventually changed with the amendments made to MA. The company works more with personal home care providers, but is just getting into home health care as well, Friedell told HHCN. The Helper Bees acquired healthAlign last year.
Since Friedell spoke at the Home Care Conference, home care usage has increased significantly among MA plans, at least according to its healthAlign’s internal data.
“We received 2,000 member referrals in all of 2021 and 12,000 in the first six months of 2022,” Friedell said. “We helped MA plans fulfill 2,500 encounters in the home during the first week of August, which was about 10 times what we saw in the first week of August in 2021.”
That increase has come as MA plans are giving members the choice to self direct benefits into the home, which is creating a growing marketplace for at-home care services, Friedell said.
Home care companies are increasingly falling into two camps when it comes to engaging with MA plans on non-primary health related benefits and Special Supplemental Benefits for the Chronically Ill (SSBCI).
Some providers believe that working with MA plans is imperative, as more seniors and Medicare beneficiaries are signing on with those plans. Others believe that the economics are not there yet to make it worth their while.
“You do see those sort of two schools of thought around this,” Friedell said. “But for sure, the providers that have been most successful with us are those who are dedicating caregivers to this more intermittent opportunity for home care. And that’s where I think you see this disruption that’s taking place in MA. It is kind of creating a different marketplace for independence-at-home services.”
In other words, these are not always cases that end up yielding a client for years to come – at least at first. But there still is plenty of volume, as Friedell mentioned.
But providers such as the Chicago-based BrightStar Care, for instance, believe these intermittent cases could still yield longer-term clients.
“If 7 out of 10 new Medicare enrollees are enrolling in Medicare Advantage, and 50% of Medicare will be Medicare Advantage in the next 10 years, well, that means that every single enrollee that is accessing their benefits is going to start with hours of personal care being paid through the Medicare Advantage plan,” BrightStar Care CEO Shelly Sun told HHCN in June. “Only those additional hours beyond that will be private pay.”
From healthAlign’s standpoint, the company is trying to make providers’ dedication of resources and time to MA worth it.
It’s built a platform that automates credentialing, referral management and documentation, while also paying out providers every 14 days. On the other end, if an MA plan can go through healthAlign to access a broader range of providers, it makes it easier on them. Some providers have also entered into direct partnerships with MA plans, too, however.
As the opportunity increases with a higher volume of potential cases, Friedell still sees this as a new, worthwhile frontier for home care providers.
He also believes that home care providers can do plenty on their own end to become more preferable and efficient partners to MA plans moving forward.
“It’s hard to get services fulfilled in the home; there’s a ton of complexity to it,” Friedell said. “And what payers are saying they must have in order to invest in care in the home is reliable fulfillment, better data visibility and a more simple mechanism for administration. So that’s also where we’re approaching this from.”
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