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October is normally a pretty eventful time for home health and home care operators. This year will certainly be no different, particularly when it comes to emerging Medicare Advantage (MA) opportunities.
As Medicare-certified home health agencies await the final payment rule that comes out at the end of October, home care companies will be closely following all the big MA players as they tout new benefits packages for the upcoming plan year. Medicare open enrollment for 2022 coverage starts on Oct. 15 and continues through Dec. 7.
For the 2022 plan year, I expect MA plans to:
— Modestly increase investment around in-home care supplemental benefits, especially ones aimed at post-hospital recovery
— Double down on benefits focused on isolation and other social determinants of health (SDoH)
— Continue their rapid adoption of home-based palliative care programs
A few major factors will steer MA plans further toward home-focused supplemental benefits, I believe. Those factors include the COVID-19 pandemic and lessons learned since the Great MA Expansion began for the 2019 plan year, as well as increased oversight from the Biden administration.
Getting up to speed
For those who haven’t been following Medicare Advantage developments over the past three years, here’s a quick recap.
In April 2018, the U.S. Centers for Medicare & Medicaid Services (CMS) announced that plans would be able to offer certain “non-skilled” in-home care benefits to members for the 2019 plan year, as long as benefits were mostly related to health needs. That action created quite the stir in the home care community, with historically private-pay agencies able to dream about MA business for the first time.
Yet the CMS announcement didn’t give MA plans much time to craft packages for the following year, which contributed to just 3% of them offering in-home support services such as personal care and housekeeping, according to AARP statistics.
A year after the initial expansion, CMS gave MA plans even greater flexibility via the Special Supplemental Benefits for the Chronically Ill (SSBCI) option. As a result, hundreds of plans opted to offer new and innovative supplemental benefits to members for the 2020 plan year.
“This is such a big change,” Anne Tumlinson, founder and CEO of ATI Advisory, told Home Health Care News at the time. “There’s a lot of risk for health plans when stepping out on this ledge. And so the fact that even some of them are doing it is very encouraging, and I’m optimistic that it will grow over time.”
With plans having two expansion avenues at their disposal while designing benefits for 2021 and some experience under their belts, there was a huge uptick this year.
The number of MA plans offering SSBCI increased to 942 plans in 2021, according to ATI Advisory data. There were also 429 plans offering primarily health-related in-home support services benefits, including those tied to Anthem (NYSE: ANTM), Humana (NYSE: HUM), Centene (NYSE: CNC) and other large insurers.
Lessons learned
There were several hundred plans offering in-home support services benefits in 2021, plus hundreds more offering benefits related to bread-and-butter home care services such as transportation or meals. That didn’t translate into a huge business boost for agencies, however.
First of all, home care operators had a very difficult time even sourcing potential MA opportunities. Additionally, those that did often found MA plans were only offering narrow home care-related benefits with relatively few hours of service for eligible members.
In 2020, for example, Amerigroup’s Medicare Advantage plan offered a personal home helper benefit that featured up to 124 hours of an in-home personal care aide for assistance with activities of daily living (ADLs).
That’s a lesson Senior Solutions Home Care learned fairly quickly, according to CEO and founder Kunu Kaushal.
“Because they either don’t have the experience or … [because] they like the idea of having the benefit without really any understanding of the burden and how difficult it is, there have been some [conversations about having] very short hours,” Kaushal said during the 2021 HHCN Medicare Advantage for Home Care Virtual Summit.
In conversations I’ve had with health plans leaders, many have said in-home support service benefits and others related to in-home care are extremely popular among their members, which helps with retention. On top of that, being able to advertise something like a personal care benefit also helps attract new members.
That’s partly why the benefits themselves have been relatively limited. Plans are testing the waters before diving in, though they still find value offering home-focused supplemental benefits as a marketing tool.
“Supplemental benefits have been an important differentiator among MA plans since the program’s inception, allowing prospective members to identify plans that offer additional benefits specific to their needs,” a February 2021 data brief from the Better Medicare Alliance reads.
Another important lesson learned has been the clear interest in home-based palliative care. Over the past three years, the number of MA plans offering home-based palliative care benefits has jumped from 39 to 128.
I foresee that trend continuing, with interest partly fueled by the community-based palliative care talks in Congress.
What to expect in 2022
The home care world will know what at least some plans are doing for 2022 within the next several days, as press releases start flying across the internet. Previously, ATI estimated that the number of plans offering in-home support services through the primarily health-related pathway will reach upwards of 540 next year.
One of the biggest priorities for health systems and plans during the COVID-19 pandemic has been keeping patients and members out of riskier health care settings. That priority remains, which will encourage even more MA plans to start thinking about the home and how it fits into their supplemental benefits.
SCAN Health Plan is one example of an MA plan that has successfully used the home to prevent potential hospitalizations or re-hospitalizations. Its “Returning to Home” program is a post-hospitalization initiative for SCAN’s MA members aimed at preventing readmissions and solidifying the discharge process. The goal of the 30-day benefit: to allow SCAN members to “get back to their baseline” and safely recover in at home, Lisa Roth, vice president of care coordination at SCAN Health Plan, previously told HHCN.
“We provide eligible members with in-home personal care and homemaking services that we have contracted with 24 Hour Home Care on,” Roth told HHCN in 2019. “We also provide home-delivered meals. A lot of times, individuals are discharged from the hospital and may not be prepared with everything lined up at home.”
The pandemic has likewise intensified the spotlight around senior isolation and senior loneliness, both of which can have a devastating impact on overall health and wellness.
For 2022, it’s safe to say that more plans will increasingly turn to companionship partners like Papa, in addition to traditional home care agencies.
Social isolation impacts roughly 43% of people 65 and older on a regular basis, Robin Caruso, coordinator of Anthem’s Member Connect program, explained during the 2021 HHCN Medicare Advantage for Home Care Virtual Summit.
“We’re looking to partner with those agencies that are innovative and looking at ways to better meet the needs of our seniors,” Caruso noted.
Finally, I think it’s important to call attention to the somewhat heightened scrutiny MA plans are currently under with the Biden administration in charge.
Earlier this month, for instance, the federal government imposed sanctions on three MA plans run by UnitedHealthcare because the health insurer spent too small a share of premium revenue on medical benefits for seniors, the StarTribune reported.
“MA plans are required to spend a minimum of 85% of premium dollars on medical expenses and can be sanctioned if they fail to do so for three consecutive years,” the StarTribune wrote. “The UnitedHealthcare plans in question failed to hit that mark from 2018 through 2020.”
With plans knowing that the government is watching, they’re going to make sure those premium dollars get spent appropriately.
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