{"id":7329,"date":"2019-07-23T08:25:32","date_gmt":"2019-07-23T08:25:32","guid":{"rendered":"http:\/\/tele.healthcare\/?p=7329"},"modified":"2019-07-23T08:25:32","modified_gmt":"2019-07-23T08:25:32","slug":"why-2020-will-launch-the-medicare-advantage-boom-in-home-care","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/why-2020-will-launch-the-medicare-advantage-boom-in-home-care\/","title":{"rendered":"Why 2020 Will Launch the Medicare Advantage Boom in Home Care"},"content":{"rendered":"\n

By Jack Silverstein<\/a> | July 23, 2019<\/p>\n\n\n\n

The Medicare Advantage revolution continues to grow \u2014 and starting in 2020, home care providers will reap the rewards.
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Through a series of law changes over the past decade, including the Patient Protection and Affordable Care Act of 2010 and the Bipartisan Budget Act of 2018, Medicare\u2019s move away from fee-for-service models and toward value-based care is sweeping the nation.
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The Centers for Medicare & Medicaid Services (CMS) calls this national shift a \u201cpart of our larger quality strategy to reform how health care is delivered and paid for,\u201d focusing on improving care for individuals, improving health for populations and lowering total costs.
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And this is where home care comes in.
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In each of the past two years, CMS has made rule changes aimed at bringing home care into the Medicare Advantage (MA) fold. The first rule, announced in 2018 for 2019<\/a>, reinterpreted the standards for health-related supplemental benefits to include additional services \u201cthat increase health and improve quality of life, including coverage of non-skilled, in-home supports.\u201d
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The second, announced this year for 2020<\/a>, expanded the definition of supplemental benefits to include any services that \u201caddress social determinants of health for people with chronic disease.\u201d
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The second rule is monumental. Yet debate remains as to when the MA opportunity for home care will reach its most fertile point.
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It could be 2020, the year in which MA plans can be as creative as they want in offering benefit packages with non-medical, in-home services. It could be 2021, the first year in which data showing outcomes and impact of home care is available, as well as a full year for plans to adjust their reimbursements to the liking of home care providers.
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It could be 2022 or beyond, assuming that just one year is not enough to get everyone \u2014 providers and payers \u2014 into the pool.
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Our new report, \u201cThe New Medicare Advantage Opportunity in Home Care<\/a>,\u201d shows the changes coming in the next few years, and reveals the key reasons why home care providers who want to jump into MA have wisely already done so for 2020.<\/p>\n\n\n\n

\u201c2019 is a very skinny, little, experimental year that is just reflective of some regulatory changes CMS made,\u201d Medicare Advantage expert Anne Tumlinson, founder of Washington, D.C.-based research and advisory services firm Anne Tumlinson Innovations, told HHCN. \u201c2020 is really year 1 \u2014 the year where CMS is now implementing a new law (\u2026) .\u201d<\/p>\n\n\n\n

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Value-based care, home care and MA<\/strong>
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The national shift in health care from fee-for-service to value-based care has been nearly as comprehensive as it has been fast.
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A recent Change Healthcare study<\/a> concluded that over a five-year period, the number of states and territories implementing value-based reimbursement (VBR) programs increased seven-fold. The study shows that value-based reimbursement models now exist in 46 states plus the District of Columbia and Puerto Rico.
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To put it simply, the U.S. health care system is moving away from treating people only when they\u2019re sick, instead focusing on proactively keeping them well. While insurers want to keep costs down in either fee-for-service or value-based care, namely by limiting the time members spend in high-cost, acute settings, a value-based model intensifies that focus. Payments are predicated on cost and outcomes, not just services delivered.
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Increasingly, insurers are realizing the role social determinants of health (SDoH) play in driving those outcomes. SDoH refers to the impact that an environment has on a person\u2019s health, such as where they work, how they commute or, crucially with seniors, where they live. A senior with a disability or chronic health condition, whose mobility is limited, spends a lot of time in these settings.
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And while different sources offer different estimates of the savings of home care vs. other settings, all agree that the longer a person stays in their home, the more money is saved, whether to the senior or the payer.
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The money is big.
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A May 2019 study from the Johns Hopkins Bloomberg School of Public Health estimated a hypothetical incremental cost savings of $4 billion in Medicare spending<\/a> if community-living adults 65 or older with disabilities received non-medical care, specifically around household activities, mobility and self-care.
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Those three areas reside at the heart of home care\u2019s value. That\u2019s what makes the CMS expansion so significant for home care providers: It lets them receive Medicare reimbursement by tapping into MA, which now serves 34% of all Medicare beneficiaries, with 22 million total enrollees.<\/p>\n\n\n\n

Efforts to keep seniors in their homes typically take three forms:
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