As PACE Grows, Here’s What Providers Need To Know About Getting Involved In The Model

During the pandemic, some senior care models succeeded, and some didn’t. The Program of All-Inclusive Care for the Elderly (PACE) was one that did. In 2023, PACE enrollment exceeded 70,000 participants and has seen an over 40% growth in enrollment since 2019. Many home-based care providers have already gotten into PACE. The Jacksonville-based Alivia Care […]

For Home Care Providers Still Invested In Medicare Advantage Business, Patience Is Wearing Thin

Around 2019, Medicare Advantage (MA) was all the rave among home care providers. That’s because, in 2018 and 2019, two pathways opened for MA plans to provide more benefits to beneficiaries: the primarily health-related benefit pathway and the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway. Included in those were plenty of areas of […]

‘You Want A Value-Based Care Strategy’: Tips For Home Health Providers In A Managed Care World

Generally, home health agencies have expressed dissatisfaction with payment rates and reimbursement policies set by managed care companies. Negotiations around rates can often be contentious. In 2024, however, providers can win with the correct focuses in mind. “You don’t want a managed care strategy; you want a value-based care strategy,” Anne Tumlinson, founder and CEO […]

Report: Disparities Emerge In Those Seeking LTSS As They Age

People who are 55 years old, and living in a community setting in the U.S., are seeing major disparities when it comes to long-term services and supports (LTSS) needs, a new report from research and advisory firm ATI Advisory found. ATI Advisory found that these disparities exist by examining race, gender and geography. The report […]

Seniors Aren’t Getting Enough Financial Support To Afford Home-Based Care

Though the vast majority of seniors are living in their communities, as opposed to assisted living or nursing homes, only a third of these individuals are receiving financial support or assistance from Medicaid to pay for home- and community-based services. That’s one takeaway from a recent Kaiser Family Foundation (KFF) webinar. Seniors that aren’t getting […]

Aetna Bucks Medicare Advantage Trend, Continues To Invest In Home-Based Care Benefits

Funding for fee-for-service home health care and home- and community-based services ebbs and flows. But the payer source most likely to dictate the future of home-based care providers – across the board – is Medicare Advantage (MA). MA plans aren’t immune to tough rate environments, either. In fact, they’re in one right now. That’s one […]

‘Do The Homework’: What Home Health Providers Need To Know Before Sitting Down With Payers

Diving into value-based arrangements with payers always sounds good, in theory, for home health providers. But it is easier said than done. Providers have to commit to value-based care, but even before that, they need to do their homework to be successful over the long haul. Moving away from fee-for-service and moving toward risk through […]

Medicare Advantage Plans Pulling Back On In-Home Care Supplemental Benefits

Insurance companies selling Medicare Advantage (MA) plans have been facing increased scrutiny from members of Congress and regulators, with critics of the private version of Medicare claiming carriers are profiting far too much. In light of those sentiments and expected constraints, some believed MA plans could begin trimming their supplemental-benefits packages, which could lead to […]

The GUIDE Model’s Promising Goals For Supporting Caregivers

When the Centers for Medicare & Medicaid Services (CMS) first announced the Guiding an Improved Dementia Experience (GUIDE) Model in late July, there was excitement and an eagerness to learn more from home-based care providers. The goal of the model, according to CMS, is to “support people living with dementia and their unpaid caregivers.” Even […]

CMS Unveils AHEAD Model, Aims To Shift Health Care To ‘Community-Based Settings’

The Centers for Medicare & Medicaid Services (CMS) unveiled a new state-focused demonstration model Tuesday. One of the model’s primary objectives is to shift health care spending and utilization more toward primary and community-based care. The States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model) will aim to better address chronic disease, behavioral […]