{"id":6844,"date":"2019-04-06T16:53:55","date_gmt":"2019-04-06T16:53:55","guid":{"rendered":"http:\/\/tele.healthcare\/?p=6844"},"modified":"2019-04-06T16:53:55","modified_gmt":"2019-04-06T16:53:55","slug":"home-care-providers-look-ahead-as-medicare-advantage-evolution-continues","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/home-care-providers-look-ahead-as-medicare-advantage-evolution-continues\/","title":{"rendered":"Home Care Providers Look Ahead as Medicare Advantage Evolution Continues"},"content":{"rendered":"\n

Home care providers slow to chase Medicare Advantage business opportunities may now be motivated to speed up their pursuits.
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Last week, the Centers for Medicare & Medicaid Services (CMS) announced it was broadening the range of supplemental benefits Medicare Advantage (MA) plans can offer in 2020. Starting next year<\/a>, health care policymakers will allow MA plans to cover any benefits that \u201chave a reasonable expectation of improving or maintaining the health or overall function\u201d of beneficiaries with chronic conditions.
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While the language is brief, its implications are enormous, CareLinx President and CEO Sherwin Sheik told Home Health Care News. Burlingame, California-based CareLinx is a nationwide online care platform with more than 300,000 caregivers in its network.
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\u201cNo one has been able to quantifiably show in a peer-reviewed journal \u2026 exactly how addressing social determinant factors of health provides strong ROI and returns,\u201d Sheik said. \u201cWith the language of \u2018have a reasonable expectation of improving,\u2019 what CMS is doing is allowing health plans to really experiment.\u201d
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In April 2018, CMS announced it was for the first time adding non-medical in-home care<\/a> as a supplemental benefit for MA plans for the 2019 plan year. While providers immediately viewed the news as a win for the home care industry, health plans were left with little time to put benefit plans together and with questions on what services they were actually allowed to offer.
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As a result, just 3% of MA plans<\/a> offered in-home support services such as personal care or housekeeping in 2019, according to an AARP analysis.
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\u201cHealth plans were asking CMS for clarification,\u201d Sheik said. \u201c\u2019Are we ok trying to do this? Can we do that?\u2019 What CMS is basically saying now is, \u2018We know you\u2019re experimenting. We know you\u2019re learning. We want you to invest here and see what happens.\u2019\u201d
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Not waiting until 2021<\/strong>
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CareLinx \u2014 purchased by Generali Global Assistance, part of the Generali Group, in 2017 \u2014 has been among the more active companies in the home care space in terms of Medicare Advantage positioning.
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In December, CareLinx launched a turnkey offering<\/a> for MA plans looking to incorporate non-medical home care as a supplemental benefit. In line with that launch, CareLinx in February acquired the Optimal Aging platform<\/a> from Providence St. Joseph Health, one of the country\u2019s largest health systems.
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\u201cWe\u2019ve been working with and helping some of the largest health plans in the country trying to figure out how to roll this out,\u201d Sheik said. \u201cThis is all new.\u201d
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Omaha, Nebraska-based Right at Home and Denver-based Homewatch CareGivers are equally bullish on what Medicare Advantage could mean for their businesses moving forward. Both have had conversations with insurers about the value of in-home services and supports.
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\u201cWhile we were a bit surprised the government was already expanding the range of services that can be covered in an MA plan, we certainly view it as a positive,\u201d Kerin Zuger, vice president of business development and strategic partnerships at Right at Home, told HHCN. \u201cThis illustrates that CMS recognizes the inclusion of non-skilled services in the home, will reduce the cost of care and enable Medicare Advantage members to remain at home longer.\u201d  
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After several discussions within health plans following CMS\u2019s initial MA announcement last year, Right at Home began working on a home care pilot with one unnamed insurance carrier, Zuger said. The franchise system hopes to go to market with benefits developed as part of the pilot as early as 2020, with collected data also being used to pitch Right at Home to other MA plans in the future.
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\u201cAs data from these programs begin proving how [new benefits] reduce the use of more acute care, we suspect home care benefits will expand further,\u201d she said.
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Meanwhile, local Homewatch Caregivers offices have been connecting with Medicare Advantage organizations in their markets with the goal of becoming in-network providers. The overall franchise company is likewise touting home care\u2019s ability to help with social determinants of health, activities of daily living, pain prevention, cognition and fall risk on a national level.
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\u201cIt is great to see that the health care system and payers, including CMS, are recognizing that far less expensive and invasive care is valuable to outcomes, as well as beneficiary engagement and satisfaction,\u201d Homewatch CareGivers COO Jennifer Tucker told HHCN. \u201cWith that said, we understand this is just a first step and it will be an evolution as we objectively demonstrate the ROI of in-home support services specifically on outcomes and costs, particularly for those patients with chronic conditions.\u201d
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Jennifer Ramona, Homewatch CareGiver\u2019s vice president of strategy and health care innovation, told HHCN the franchise is \u201cdoubling down\u201d on Medicare Advantage, including taking the step of creating a new position to support offices with pursuing MA business.
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\u201cWe want to be engaged with the MA plans early in order to help inform the expectations of a home care partner to be able to demonstrate value to the plan and their enrollees, and in return for home care providers to be able to expect fair requirements and reimbursements from the plans,\u201d Ramona said. \u201cWe are not waiting for 2021.\u201d
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Not an easy business<\/strong>
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Apart from home care providers, the Better Medicare Alliance has also been among the groups praising CMS for expanding supplemental benefits under Medicare Advantage.
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Washington, D.C.-based Better Medicare Alliance is an association of more than 130 health care organizations and more than 400,000 beneficiaries. President and CEO Allyson Schwartz called the finalized MA policies for 2020 are \u201ca game-changer\u201d in health care delivery.
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\u201cThe announcement offers a continuation of a positive and stable environment for Medicare Advantage that allows plans and providers to continue to offer high quality, affordable care for millions of beneficiaries,\u201d Schwartz said in a statement.
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Despite ambitious plans, home care providers and franchise networks should take a comprehensive look at their operations before pursuing MA opportunities, Sheik said, noting some may struggle with certain logistical challenges from insurers.
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\u201cIt\u2019s not easy business,\u201d he said. \u201cThe MA program is not what traditional home care is set up for. Traditional home care wants that 20- to 30-hours-per-week client who lasts about a year. That\u2019s definitely not what Medicare Advantage is.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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