Now more than ever, Medicare Advantage (MA) organizations are including home-based care services in their plans. While some organizations are giving their members access to these offerings for the first time, others have long embraced home-based care.
One of these early adopters is SCAN Health Plan, which is one of the nation’s largest not-for-profit MA plans, serving more than 273,000 members. The Long Beach, California-based MA plan is part of the SCAN Group, a nonprofit organization focused on helping senior citizens stay healthy and independent.
With that goal of keeping seniors healthy and independent in mind, home-based care has always been a key tool in achieving this, Jill Selby, SVP of product development, marketing and market expansion at SCAN Health Plan, told Home Health Care News.
“If you speak to an average senior they will tell you they want to live on their own for as long as they can,” she said. “They want to live in their own home. In-home services really help to meet that goal.”
Next year, SCAN Health Plan will be one of the at least 1,091 plans including in-home support services as part of its offerings in 2023. Along with SCAN Health Plan, Humana Inc. (NYSE: HUM), UnitedHealth Group (NYSE: UNH), Cigna (NYSE: CI) and Aetna will also give their members access to these services next year.
One of the offerings is what SCAN Health Plan has dubbed their “returning to home” benefit. It gives a member that’s been in the hospital or a skilled-nursing facility for at least a one-night stay access to between 40 to 60 hours of in-home caregiving annually.
“Coming home from a hospital stay is pretty difficult and we want to make sure when they get discharged home their inability to care for themselves doesn’t cause them to go right back to the hospital,” Selby said. “They haven’t had anybody to help them with food preparation, or sometimes people even come home from the hospital without having a shower or bath in a week or more.”
In order to pull this off, SCAN Health Plan contracts with providers it has existing relationships with and deploys these caregivers into a member’s home.
The other benefit the organization offers is respite care for members that have an unpaid, informal full-time caregiver. These members are eligible for up to 40 hours of respite care per year.
Additionally, SCAN Health Plan offers companion services for a new plan focused on the LGBTQ community, which the organization is rolling out next year.
“We are going to start with that particular plan, see how the effects of the companion services go and then hopefully broaden that in 2024,” Selby said.
While offering home-based care services aligns with SCAN Health Plan’s mission, there’s also a business case for offering home-based care.
In fact, a recent BrightStar Care study — conducted by Russell Research — found that 88% of respondents are more likely to pick a MA plan that offers more personal care hours.
Plus, 86% of respondents expressed that they wouldn’t consider using services from a personal care agency if it did not accept their MA plan.
“These rising statistics showcase how rapidly the health care industry is evolving in a direction where Medicare Advantage and other reimbursement models are becoming widely accepted by personal care agencies,” Shelly Sun, founder and CEO of BrightStar Care, said in a press statement.
On its end, SCAN Health Plan is looking to form relationships with home-based care providers that have a proven track record of quality care.
“A home-based care agency looking to join SCAN’s network is required to be in good and active standing with all applicable state and federal regulations and to have demonstrated a commitment to providing top-quality care in the home to older adults,” Selby said.
Clover Health is ahead of the trend
Like SCAN Health Plan, Clover Health (Nasdaq: CLOV) has long seen the value-add in offering its MA members home-based care services.
“Clover has been providing home based care since 2017,” Jessica Son, chief medical officer of Clover Home Care, told HHCN. “I like to say that they’ve been doing it before it got really trendy.”
Headquartered in Nashville, Tennessee, Clover Health is a technology-enabled MA insurer with its own in-house clinical capabilities.
Home-based care has allowed Clover Health to expand its reach.
“[Some of our members] are actually quite homebound, meaning it’s very difficult and or impossible to leave the home,” Son said. “That can mean their caregiver … has to take an entire day off of work to get them to an office, or they spend an entire day on the bus. We believe that people have better things to do than to wait in a doctor’s office.”
Son noted that, to date, Clover Health has reached “tens of thousands of members in their home.”
Eyes in the home have also given Clover Health additional insights into all of the driving factors that might lead a member back into the hospital.
Next year, Clover will offer its “Clover Care Visits,” which is a technology-enabled comprehensive annual assessment of a member’s needs.
“We take that information – anything that comes up – whether it is help with getting their medications, or needing to find a home-based care provider, or they’re struggling with behavioral health issues, and we ensure that we make the connections necessary,” Son said.
The organization also has an in-home care benefit for its members that need more intensive care services.
Son believes this is as the demand for home-based care rises, there’s room to continue growing.
“There are many opportunities yet to be solved in the home,” she said. “That’s why I think having the spotlight is really exciting, because it’s not just about home-based primary care, or home health or hospice, it really is that integrated home-based ecosystem.”
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