Across the nation, home health care agencies and related provider businesses have renewed interest in capitalizing on the opportunity which Medicare Advantage plans presents, by way of usage as a supplemental benefit. As homecare agency management mull over the details, the actual girth of the overall benefit is yet unclear.
It is predicted that most home health care providers won’t realize any monumental changes to MA plans in the coming year, but the overall outlook over the next 3 years could only offer marginal if not miniscule gains. There will undoubtedly be more emphasis placed on home health and homecare providers exhibiting the monetary cost savings as well as overall worth of their services.
A significant motivator for MA plans to increase the availability of supplemental benefits will always be total plan enrollment numbers. The drive of the plans will seek to bring in as many new enrollees as possible, with a good offering of cost effective pricing and the quality of benefits. Organizations insuring through MA, are required to turn in health plan bids to participate in the program, which mandate that certain requirements pertaining to coverage limit cost, and available services are met up front. Any high cost service or patient benefit housed in such a plan would stress the tight margin of profitability potential, and run the risk of hiking premiums to those who would struggle to afford it. The situation presents a catch twenty two, one official was cited as commenting. To bring in additional enrolled members, the initial bid would need to presumably be at a lower cost since the first and foremost goal is to bring in new enrollees. However, the more benefits that are unknown or uncharted proposed for any plan which would present challenges in pricing, the higher the requirement that the bid hold a higher number.
Clear cost savings are the only proven driver that would solidify non skilled home care supplemental benefits into the MA program. This in turn places the burden on agencies to demonstrate clearly the value of the services they are providing, and to do so in such a way that the data is clear and easy to digest. For example, if data exists that exhibits that the services a home care provider is offering are known to reduce hospitalizations, it becomes a much easier sell to the powers that be. If it is demonstrable that the cornucopia of services home care provides, which could include everything from providing affordable meals, patient hygiene, transportation etc, are reducing visits to the ER and the hospital for patients, it is a win/win.
Without solid irrefutable data that supports the assumption that such services are valuable cost savers for all involved, contracted MA plans could be less attainable outside of individual providers willingly assuming a higher level of risk. A proposed deal of sorts where homecare agencies swapped adding more risk to their business model in exchange for the addition of a more robust offering of in-homecare services, could be on the horizon as the new standard in the coming years.
Adding a bit of complication to the mix is the fact that there is a waiting period before non-skilled services can be truly considered a benefit within an MA plan. On paper, supplemental benefits as a whole have already been expanded for the year 2019, hence plans have a higher chance of adding them in 2020 and subsequent years.
The going assumption is that for the initial years to come, managed care businesses will gradually begin to add in-home care benefits in modest measure. There have already been examples of some larger companies leaving ambiguity within the traditional pantheon of payer and provider. This can be seen in their embellishment of MA benefits by way of the inclusion of specific services that directly deal with social influencers of health and patient needs in the home. It is anticipated that health plans will begin flirting with the idea of experimentation with how they deal with supplemental benefits.
Regardless of these new developments, for a large number of industry players, MA plans and businesses offering managed care, the inclusion of home care as a benefit may take some time to become prominent. A gradual shift to the Medicare program is the far more likely scenario, as education and industry wide adoption becomes more ubiquitous. This does create modest growth opportunity where improved outcomes meet extra profit for many agencies going forward, and to that end, many are already looking ahead to the bigger picture.
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