Medicare Advantage (MA) has been viewed over the last few years as a new space for home-based care providers to generate revenue.
Changes have allowed MA plans to pay for additional at-home services, whether through primarily health-related benefits or Special Supplemental Benefits for the Chronically Ill (SSBCI).
Those changes aren’t major on the surface, and adoption hasn’t been as swift as some would like. But that shouldn’t deter MA interest for home-based care providers, Andy Friedell, the founder and CEO of healthAlign, said at the Home Health Care News Home Care Conference in December.
“We have pretty good insight into what you see take place over a period of time when these public policy changes occur,” Friedell said. “And to us, while this was a seemingly small change in the Medicare regulations, allowing more flexibility for MA plans to offer some of these services at home … can create a huge shift over time.”
healthAlign is a convener of home-based care services. Essentially, it has a platform that enables payers to interact with a slew of home-based care providers at once – and it makes those relationships more seamless.
Traditionally, Medicaid was the healthAlign team’s focus. That has changed with the amendments made to MA.
“Our history was mostly on the Medicaid side, in home care,” Friedell said. “And so we had a really good perspective on the services that are required or needed for a member who has long-term care needs and wants to stay at home.”
Friedell points to Medicaid as evidence for his bullishness on MA. When similar doors were opened for Medicaid in the 1980s, it went largely unnoticed. But over time, it’s created a huge shift in the kind of services Medicaid pays for.
“If you go back several decades, there was a time where Medicaid did not pay for any services in the home,” he said. “And there was this seemingly small change in a pretty obscure piece of legislation in the early 1980s that Congress enacted. At the time, it didn’t get the attention it may have deserved. But it opened the door for Medicaid to start covering services in the home.”
Since, home-based services have gone from having a 0% share spend in Medicaid to over 60%, where it has now surpassed institutional spend.
“At the same time, the overall share of long-term care spending in Medicaid went from over half of its spending to under a third,” Friedell said. “So what that means is that Medicaid, it experienced some public policy changes, and it created these benefits in the home. And ultimately, it had the effect of essentially creating room for the program to spend more dollars elsewhere.”
The federal government – in shifting more care into the home – has seen a sizable return on its investment.
healthAlign’s dedication to the home and the MA shift led to a similar company – The Helper Bees (THB) – acquiring it in May. Traditionally a long-term care convener, THB saw value in creating a convener platform that was enabled across the continuum.
On Jan. 11, The Helper Bees announced it closed $12.8 million in Series B funding, led by Trust Ventures. That comes on the heels of what the company called “significant growth,” in part due to the healthAlign acquisition.
THB plans to use the funding to expand its aging-in-place marketplace.
What The Helper Bees and healthAlign are betting on is that a looming shift in MA will mirror that of Medicaid’s. Plus, tailwinds created by COVID-19 should undoubtedly speed up that shift, in their minds.
“That’s what we talk about when we engage with some of our providers – not to look at it from this point in time, and at the seemingly small changes today,” Friedell said. “We see it as kind of opening the door for a similar trajectory of incremental adoption. Certainly, the long-term return on investment that we expect is like the one [providers saw] in Medicaid.”
Close to 15% of MA plans will offer primarily health-related in-home support services in 2022. Meanwhile, the amount of plans with SSBCI offerings has seen a significant increase, according to a recent report from ATI Advisory.
In 2022, nearly 1,300 MA plans will be offering SSBCI. Hundreds of plans will offer benefits crafted around social support and “general supports for living.”
“I think we expected to see growth in the number of plans offering SSBCI, and the data has confirmed that,” Elexa Rallos, an analyst at ATI, previously told HHCN. “We were expecting to see big growth in the benefits that a lot of members are asking about – things like food and produce and meals. But we’re also seeing a lot of growth in newer, more non-medical benefits – things like transportation and this general supports for living benefit, which is really interesting.”
It isn’t just about adoption of the benefits, either.
Plans are also allowing more paid hours for at-home services within their benefits, according to Friedell.
“We had one of the first contracts with a nationwide MA plan to offer one of these benefits back in 2019,” he said. “I would say at that point in time, the volume and utilization of service was negligible. There was really not a lot of usage of that service. But then in 2020, it really came out strong. There was a huge growth of adoption, hours and members using these new benefits. In 2022, we will see probably close to a four-fold increase again on adoption of these services.”
Plans used to offer a low, fixed number of visits or hours for at-home benefits. But that’s beginning to change.
“What we’re seeing going into next year is plans starting to think about and recognize that this really limits both the case manager and the member, because members’ needs are constantly changing,” Friedell said. “They’re starting to look at ways to use value instead of fixed numbers. … Giving members that kind of additional flexibility, I think that’s another big change that we’re just starting to see. And that’s good for the member [and providers].”
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