For more than a year now, home care has taken center stage in the discussion surrounding Medicare Advantage (MA). Things were no different at last month’s MA Summit, hosted by the Better Medicare Alliance (BMA) in Washington, D.C.
There, health care leaders from a variety of sectors and legislators from both sides of the aisle came together to discuss MA trends. One resounding takeaway was the importance of home care — and the struggle to successfully integrate it into MA plans.
In between sessions, HHCN sat down with BMA President and CEO Allyson Schwartz, who shared her views on how home care has forever changed the MA game. Schwartz, a Democrat, is also a former member of the United States House of Representatives.
First of all, as the organizer of this event, what are some of the key takeaways from the discussions going on here — or even just from the past year as it relates to MA?
One of the very significant changes that has been made in the past year or two is this redefinition and expansion of the kinds of supplemental benefits that can be provided — and that they can actually be targeted to a population particularly in need.
That is a game changer for Medicare Advantage and the Medicare beneficiaries they serve.
We’re excited about the opportunities to address social determinants through some of these new flexibilities. We’re hearing [about] the keen interest in transportation to appointments, for example. Then, we also hear about nutrition and meals as being important, as well as care in the home.
You heard about that [already,] particularly from the president and CEO of Humana, [Bruce Broussard,] talking about care in the home, … not just [following] post-acute stays, but to actually be able to prevent those hospitalizations and to support [member] health.
In 2019, plans were slow to adopt these in-home care supplemental benefits. What do you think needs to happen to speed up that process and result in a wider rollout of in-home care benefits?
For 2019, the timing was difficult. The announcement of these changes happened about five weeks before the bids were due. So there’s background work to do in making decisions about these supplemental [benefits].
There were no additional funds for these services. People think, ‘Oh, they must have gotten funding for all of these new supplemental benefits.’ They did not. The plans will still be getting the payments they would have gotten anyway.
They do have to make decisions … about which services they think they could afford to provide.
Do they have to reduce some other services in order to do that? Or, in fact, do they believe that the return on investment would be significant enough to move ahead on these additional benefits?
A number of these benefits are targeted to people with chronic conditions, so these are not universal necessarily. They are ones you get a referral to if you have a chronic condition that warrants it.
[Plans] have to figure those populations out, how they’re going to target them and, of course, how they’re going to afford to do it within the payment they already receive from CMS.
Date: August 23, 2019
Source: Home Healthcare News