Evaluating Home Care’s Progress in Medicare Advantage

Many of the in-home supplemental benefits offered by Medicare Advantage (MA) plans are new. But whether they are through the primarily health-related pathway, which began in 2019, or through Special Supplemental Benefits for the Chronically Ill (SSBCI), which came a year later, these benefits are still being experimented with.

Generally, the plans offering these new benefits are what you’d call “early adopters,” and maybe even “innovators,” if we’re assigning labels based on Everett Rogers’ “Diffusion of Innovations” theory.

With the newest SSBCI data for 2022 coming out last week, I thought it’d be a good time to evaluate where the home care industry is at with its entry into the MA world. One key takeaway: While plenty of plans have dipped their toes in the water on new home-focussed supplemental benefits, others are diving in head first.

“When talking to plans, we’ve heard a lot about the challenges and reluctance around adding these benefits because it’s a new area,” ATI Advisory’s Tyler Cromer told me last week. “There’s constraints, there’s funding [issues], and then there’s getting the attention of executives of health plans. But we’re hearing less and less about that.”

So the MA landscape is evolving, but two crucial questions around these benefits remain.

Firstly, if you’re an MA plan, is it worth it to actually invest in services like in-home support, companionship, transportation and meals? Do those offerings attract new members – or keep existing ones out of the hospital?

Secondly, if you’re a home care operator, is the time and energy spent chasing MA business currently delivering an acceptable ROI?

‘The new MA’: Numbers you need to know

The primarily health-related benefit pathway allows MA plans to offer services that are as they sound: more directly related to a member’s health. In-home support services are one of those offerings.

In 2022, close to 15% of all MA plans, about 1,000 in total, will offer in-home support services, according to the Washington, D.C.-based research and advisory firm ATI Advisory. In-home support services are unique, though, in the fact that they can be offered through SSBCI as well.

Adult day services and home-based palliative care are also primarily health-related benefits. These are currently utilized by 50 and 147 plans, respectively.

Meanwhile, SSBCI includes a slew of benefits that can be offered in the home, or at least can begin there. For instance, the top SSBCI offerings from MA plans this year will be: food and produce, meals beyond a limited basis, transportation for non-medical needs and general supports for living.

General supports for living covers all kinds of housing needs that help seniors age in place. It includes assistance for things like plan-sponsored housing consultations or subsidies for rent, as well as subsidies for utilities such as gas, electricity and water.

Other home-related benefits included in SSBCI are pest control, home modifications and “social needs.”

Through the social needs benefit, agencies can help provide services such as caregiving, as well as support for isolation and cognitive function.

Nearly 1,300 plans are offering SSBCI overall in 2022, while the most popular benefits have anywhere from 328 plans (general support for living) and 763 plans (food and produce) offering them.

Previously, the uptake of these benefits had been relatively negligible. That’s why the biggest takeaway from the 2022 data is just how much plan adoption has grown, especially over the last year.

“We’re definitely seeing the big insurers drive very drastic growth, really since last year, and go pretty heavy on some of these benefits,” Elexa Rallos, an analyst at ATI Advisory, also told me last week.

Navigating an evolving market

The MA market is dominated by the larger carriers. The top 10 plans in the country control over 75% of the market.

That means a lot of different things for the MA industry as a whole. But in the context of supplemental benefits and home care, it means that just a few insurers investing in those areas drive a lot of growth.

Humana (NYSE: HUM), Anthem (NYSE: ANTM) and Centene (NYSE: CNC) are three plans that have driven MA innovation in 2022, Rallos explained to me.

In 2021, nearly half of all plans offering SSBCI were derived from Cigna (NYSE: CI), Anthem and Humana. For these companies, the primarily health-related and SSBCI pathways allow them to directly address the social determinants of health of their members and become more medically proactive.

For the 2022 plan year, certain Humana members “who need help remaining independent at home” will have access to a personal care manager through its at-home care division. Members leaving the hospital who are at-risk for rehospitalization also have access to further in-home support services.

The Louisville, Kentucky-based health care organization has also partnered with Papa to solve for social isolation and loneliness.

Similarly, Anthem and some of its affiliated plans in 2022 will offer members up to 60 hours of in-home support from an “at-home technician” who can assist with light housekeeping, errands, companionship and other tasks.

“That all goes back to home health and redefining how we play in the health space,” Elena McFann, president of Anthem’s Medicare business, told HHCN in October. “We actually have found that our supplemental benefits like the personal home helper are ones that drive increased sales and, by the way, increased retention.”

On its end, Centene isn’t just expanding its scope of services in 2022; it’s drastically increasing its MA footprint. In 2022, the company is offering plans in 327 new counties and three new states, including Massachusetts, Nebraska and Oklahoma, bringing its total number of MA states to 36.

Other examples of usage include the California-based SCAN Health Plan, which is offering health technology to give members access to physicians from their homes as well as technology training. Another is the Idaho-based Regence — an affiliate of BlueCross BlueShield — which is offering virtual companionship through the SSBCI benefit.

Pennsylvania-based Geisinger is providing allowances of up to $1,000 to beneficiaries for personal care, meals, home modifications and more.

And while uptake may seem slow at times from the outside, one in four plans now offer some form of SSBCI. In the grand scheme of things, that’s pretty massive growth for something that did not exist a few years ago.

This is also important to point out: Part of the supplemental benefits growth has been driven by less notable plans, too. Because the marketplace is dominated by the behemoths, these smaller companies need to find a way to stand out. Some see supplemental benefits as an avenue to do so.

“I do think that plans think about these benefits as a way to differentiate themselves in a crowded marketplace,” Cromer told me last year. “And providing the right combination of benefits that really meet member needs could result in a competitive advantage in any individual market.”

Why it’s all worth it

Certainly, some in-home care providers have had their enthusiasm wane since 2018, when the government first announced that some non-medical home care benefits could be offered by plans moving forward. After all, MA has not been an immediate driver of growth or revenue.

But that could be a stance that will look near-sighted years from now.

Andy Friedell, the founder and CEO of healthAlign, explained why at the 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,” he told me on stage. “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, an all-encompassing conduit between payers and providers.

Specifically, Friedell pointed to another small change in policy that occurred in the 20th century as proof that MA, as a source of revenue for in-home care providers, should not be given up on.

“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.”

It may take time for MA benefits to develop into a true tailwind for providers, but I believe that long-term investments could pay off significantly.

For now, one of the main barriers to MA is very familiar. For one, the limited hours that MA plans currently cover make cases harder to staff. Some home care agencies favor private pay clients over others for this exact reason.

Then again, if staffing woes were a reason to stop investing in the future, you’re probably in the wrong business anyway as a home care operator.