{"id":7331,"date":"2019-07-28T08:35:45","date_gmt":"2019-07-28T08:35:45","guid":{"rendered":"http:\/\/tele.healthcare\/?p=7331"},"modified":"2019-07-28T08:35:45","modified_gmt":"2019-07-28T08:35:45","slug":"6-steps-home-care-providers-must-take-to-succeed-in-medicare-advantage","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/6-steps-home-care-providers-must-take-to-succeed-in-medicare-advantage\/","title":{"rendered":"6 Steps Home Care Providers Must Take to Succeed in Medicare Advantage"},"content":{"rendered":"\n<p>By <a href=\"https:\/\/homehealthcarenews.com\/author\/jacksilverstein\/\">Jack Silverstein<\/a> | July 28, 2019\n\n\n\n\n\n\n\n\t\t<\/p>\n\n\n\n<p>The recent rule changes to Medicare Advantage (MA) from Centers for Medicare &amp; Medicaid Services have created a level of flexibility and creativity for home care participation <a href=\"https:\/\/homehealthcarenews.com\/2019\/07\/why-2020-will-launch-the-medicare-advantage-boom-in-home-care\/\">that is nearly unchecked<\/a>. <br \/><\/p>\n\n\n\n<p>For example, the final call letter for MA plan year 2020 notes that \u201cMA organizations have broad discretion\u201d in determining what\u2019s called the \u201cSpecial Supplemental Benefits for the Chronically Ill.\u201d Among the examples of benefits: pest control.<br \/><\/p>\n\n\n\n<p>In other words, home care\u2019s place in MA is limited only by providers\u2019 and payers\u2019 imagination.<br \/><\/p>\n\n\n\n<p>But that flexibility brings new challenges \u2014 namely in operations, relationship building and technological demands. The new HHCN report, \u201c<a href=\"https:\/\/homehealthcarenews.com\/the-new-medicare-advantage-opportunity-in-home-care\/\">The New Medicare Advantage Opportunity in Home Care<\/a>,\u201d reveals the six steps home care providers must take to succeed in MA.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>1. Take both a top-down and bottom-up approach to connect with payers<\/strong><\/h3>\n\n\n\n<p>Most MA plans come from major insurers, yet the plans themselves vary zip code to zip code. That means in order to connect with payers, providers must take both a top-down and bottom-up approach. <\/p>\n\n\n\n<p>Top-down can be tricky for smaller providers without national, executive-level contacts. And bottom-up is time-intensive: There were 3,100 individual MA plans in 2018, 3,700 in 2019 and there should be more in 2020.<\/p>\n\n\n\n<p>To make these connections, Denver-based Homewatch CareGivers, <a href=\"https:\/\/www.franchisegator.com\/franchises\/homewatch-caregivers\/\">a franchiser with 200 locations in six countries<\/a>, built a three-pronged approach to help it serve as facilitator between its franchisees and MA plans:<br \/><\/p>\n\n\n\n<p>\u2014 Use national contacts to learn payers\u2019 big-picture strategies and gain national contracts<\/p>\n\n\n\n<p>\u2014 Talk to local plans with supplemental benefits related to home care<\/p>\n\n\n\n<p>\u2014 Talk to local plans that serve their home care clients<\/p>\n\n\n\n<p>While the specific plan decisions must be made at the local level, the national offices can give a valuable 30,000-foot view. Homewatch\u2019s executive team uses existing relationships in the c-suite to learn more about a given plan\u2019s overall level of interest in home care partnerships. <br \/><\/p>\n\n\n\n<p>They also use their institutional knowledge to guide their franchisees through existing contracts to locate the slivers of information relevant to a provider\u2019s clients. Homewatch views handling this process as part of its value proposition to its franchisees, for whom the task of is challenging, whether due to having little to no experience working with insurers, struggles with the often opaque process of finding plans or staffing bandwidth. <br \/><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>2. Be prepared to educate payers on home care vs. home health care<\/strong><\/h3>\n\n\n\n<p>This might sound silly, but according to a number of home care providers, major payers still struggle to understand the difference between home care and home health.<br \/><\/p>\n\n\n\n<p>\u201cI didn\u2019t realize how big of a learning curve there actually was for these payers,\u201d Kerin Zuger, vice president of business development at Right at Home, told HHCN.<br \/><\/p>\n\n\n\n<p>To combat this problem, Zuger and the team at the Omaha, Nebraska-based franchise network \u2014 which has nearly 500 U.S. locations \u2014 created a four-page brochure highlighting home care\u2019s value proposition within the MA framework. Right at Home then sent the brochure to the country\u2019s biggest MA plans to introduce themselves and their services.<br \/><\/p>\n\n\n\n<p>Titled \u201cWhy Medicare Advantage Needs Home Care,\u201d the document serves as Home Care 101. The top-line information stresses the connection between home care and social determinants of health, in addition to outlining the coming decades of home care need.<br \/><\/p>\n\n\n\n<p>Sourcing the 2016 report \u201c<a href=\"http:\/\/www.hcaoa.org\/assets\/1\/27\/Value_of_Home_Care___SECURED.pdf\">Caring For America\u2019s Seniors: The Value of Home Care<\/a>,\u201d written jointly by Home Care Association of America and Global Coalition on Aging, Right at Home\u2019s brochure focuses on four areas that illuminate the growing impact that non-medical home care can have on health-related outcomes:&nbsp;<br \/><\/p>\n\n\n\n<p>\u2014 The growing need for affordable in-home care<\/p>\n\n\n\n<p>\u2014 The impact home care has on preventing falls<\/p>\n\n\n\n<p>\u2014 The impact home care-related early intervention has on delaying institutionalization<\/p>\n\n\n\n<p>\u2014 The correlation between home care services and reduced hospital readmissions<\/p>\n\n\n\n<p>The brochure even goes one level further than high-level insights and data, providing a straightforward list of six tasks that home care providers deliver to prevent seniors from falling, such as household chores and medication reminders.<br \/><\/p>\n\n\n\n<p>The list is so simple that home care providers might not even think to mention some of those tasks to payers. But going that basic, Zuger found, is crucial to success as providers build relationships with plans.<br \/><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>3. Bulk up your technological infrastructure<\/strong><\/h3>\n\n\n\n<p>Even if all of the information barriers were gone, the data challenge would remain.<br \/><\/p>\n\n\n\n<p>\u201cWe can talk until we\u2019re blue in the face on what the value is of including personal and companion services or respite care services in a plan, but until you have the data to prove it, it\u2019s difficult for payers to really digest,\u201d Zuger said.<br \/><\/p>\n\n\n\n<p>Until payers can do that, \u201cit\u2019s hard for them to determine what specific services and hours they should include in the plan,\u201d she added.<br \/><\/p>\n\n\n\n<p>One strategy is for providers to teach their staff the connection between data procured and outcomes delivered. New York-based Premier Home Health Care, which has an MA contract with health insurer HealthFirst, is focused on aligning its data collection, especially around how home care helps reduce hospitalizations, with its staff training program. <br \/><\/p>\n\n\n\n<p>This strategy helps staff understand the quantifiable benefits home care has to insurers, allowing them to create actionable changes in care based on analytics.<br \/><\/p>\n\n\n\n<p>\u201cAs an organization, we know that \u2026 the recognition of the value that in-home support plays in keeping people out of the hospital and improving their quality of life while living with chronic illnesses will only continue to grow,\u201d said Christy Johnston, vice president of governmental &amp; managed care services for Premier. <\/p>\n\n\n\n<p>\u201cSo we will watch to identify data that helps us drill down and understand what is happening in different areas of the country that we\u2019re involved in (\u2026).\u201d<br \/><\/p>\n\n\n\n<p>To capture this data, providers need to build their technological capabilities, including electronic health record systems and electronic visit verification systems. Among the leaders in this space is ClearCare, which serves more than 4,000 home care providers, including eight of the largest 10 home care enterprises. For home care providers entering the MA space, ClearCare CEO Geoffrey Nudd sees four crucial tech requirements:<br \/><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Interoperability<\/strong> Providers must be able to connect electronically to MA plans to receive care plans and exchange patient data as part of integrated care protocols. \u201cThe handoffs between acute settings and clinical care, including home healthcare, are really critical with this population,\u201d Nudd told HHCN.<\/li><li><strong>Quality. <\/strong>Plans want to know that their home care partners are well-managed, with strong oversight of the care, screened caregivers and positive member experience. \u201cA value-based construct oriented to improving outcomes and reducing cost \u2026 requires precisely targeted, integrated, and clinically informed protocols even if the care is ultimately non-medical (and is) simply help with ADLs and iADLs,\u201d Nudd said.<\/li><li><strong>Security. <\/strong>All of MA plans expect home care agencies to use operating software that is HiTRUST certified, Nudd said.<\/li><li><strong>Scale. <\/strong>MA Plans cannot build thousands of connections to thousands of different home care agencies, let alone individual caregivers, Nudd noted. \u201cFor technology companies like ClearCare, the onus is on us to provide turnkey points of connectivity, and FHIR compatible APIs, for MA plans to reach our home care partners,\u201d he said.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>4. Deliver 24-hour services <\/strong><\/h3>\n\n\n\n<p>Though it will take at least a year for providers to begin to capture the cost and health outcomes data that payers want to see, there is one big piece of infrastructure providers can implement now to bolster their value: the ability to assist seniors and their loved ones 24 hours a day.<br \/><\/p>\n\n\n\n<p>\u201cWhen you drive by our office, our lights are on at two in the morning,\u201d Gavin Ward, regional director of strategy and partnership at Los Angeles-based 24 Hour Home Care, told HHCN. \u201cIf you can\u2019t give someone 24 hours a day, I don\u2019t think those companies should partner with MA.\u201d<br \/><\/p>\n\n\n\n<p>In MA, 24\/7 readiness means the capability to field calls and answer questions from clients and caregivers at all times. Additionally, a provider must have the technology that lets caregivers swap or reschedule shifts autonomously and lets providers quickly facilitate those reschedulings, thus reducing shift cancellations.<br \/><\/p>\n\n\n\n<p>\u201cWhat we\u2019re looking for, depending on the nature of the need, is someone who has the ability to meet the home care needs of our members in a timely manner,\u201d  Kirk Allen, president of Humana\u2019s home health segment Humana At Home, told HHCN. <br \/><\/p>\n\n\n\n<p>While CMS requires that home health providers reach a senior\u2019s home within 48 hours of their return from the hospital \u2014 what\u2019s known as \u201ctimely initiation of care\u201d \u2014 Humana looks for providers that can get there sooner, ideally within 24 hours, \u201cso that the patient doesn\u2019t seek unplanned care in the wrong setting,\u201d Allen said. If a provider delivers both home health and home care, its proven ability to promptly initiate care in home health may bode well for its ability to do so in home care. <br \/><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>5. Learn your way around CMS.gov and other sources<\/strong><\/h3>\n\n\n\n<p>Home care providers searching for the MA contracts that are right for them will quickly come to a confusing road. As stated, MA plans don\u2019t just vary by the state, but by zip code. A home care provider serving California, for instance, would find 36 contracts in June 2019 across 22 zip codes.<br \/><\/p>\n\n\n\n<p>And because some of these benefits are so new and so small, they\u2019re not always available at Medicare.gov, where providers can otherwise use the \u201cFind My Plan\u201d search tool to locate other types of benefits.<br \/><\/p>\n\n\n\n<p>Fortunately, there is enough information available publicly to find the right plans, if you know where to look. A home care provider that aims to locate the right plans for their clients needs to learn its way around several sources, most notably:<br \/><\/p>\n\n\n\n<p>\u2014 CMS.gov<\/p>\n\n\n\n<p>\u2014 Multiple spreadsheets from CMS with hundreds, thousands or even tens of thousands of data rows<\/p>\n\n\n\n<p>\u2014 Publicly available analyses of this data, such as the Milliman Report<\/p>\n\n\n\n<p>\u201cThe New Medicare Advantage Opportunity in Home Care\u201d includes a five-step process that lays out best practices on how to find MA plans with specific supplemental benefits in specific service areas, as well as an additional pro-tip source for finding plans.<br \/><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>6. Learn how to read insurance plans<\/strong><\/h3>\n\n\n\n<p>While the Milliman Report gives a great overview of plans, and the individual datasets on CMS let providers dig deeper, all of the research eventually leads to the individual plan websites and the documents that list specific benefits, known as the Explanation of Benefits (EOB) or Evidence of Coverage (EOC). These are often 200-plus page PDFs, and they provide the specific detail on the benefits a plan offers. <br \/><\/p>\n\n\n\n<p>The key takeaway here is to use all of this material in concert. An outside analysis of CMS data without the raw CMS data would mean a lot of additional digging, but the raw CMS data without these analyses would mean too much digging.<br \/><\/p>\n\n\n\n<p>\u201cThese new supplemental benefits are like budget dust in these MA plans,\u201d Doug Robertson, health care regulation and compliance manager at Right at Home, told HHCN. \u201cIt\u2019s a very small financial component of an overall plan that could cost millions of dollars to the insurance company.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Jack Silverstein | July 28, 2019 The recent rule changes to Medicare Advantage (MA) [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":5477,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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