Health Systems Need to Prepare: CMS Adds Medicare Advantage Supplemental Benefits for Non-Medical In-Home Care

Some important numbers on Medicare Advantage (MA) plans are buried in the last decade of data from the Centers for Medicare and Medicaid Services (CMS):  

• MA plan enrollees increased 20%.
• Government spending on MA plans increased 38.5%.

That’s over 1 million people and $10 billion more per year.   Now pair that with CMS’s newly expanded definition of “primarily health-related” supplemental benefits for 2019. It includes new reimbursement options for in-home care. This means more resources are being invested in the MA program to cover a growing population with expanded benefits. It’s a winning combination for health systems and patients…right?

How CMS Policy Changes Impact Health Systems

In healthcare, we can all agree it’s a good thing when patients get better access to services they need. This is especially true when that care can be delivered in the home, according to Andy Slavitt, former acting head of CMS. (You can read more about what we have to say on that here.) Still, there’s a bit of a catch for health systems. The inherent difficulties of adding or updating a service offering bring about considerable administrative weight and complexity.  This can feel daunting for health system leaders already under constant pressure to lower costs, increase revenue, and meet ever-changing patient population needs. It makes finding it critical for health systems to find a trusted home care partner. But, what does that look like?   Non-skilled in-home care means a caregiver is frequently present in a patient’s home. It means someone is making sure the patient eats on time, has transportation to doctor appointments, stays clean, and has the regular companionship and attention of someone invested in their wellbeing. When that caregiver is part of a tech-driven company, they’re also able to feed data into a system that can be monitored in real time. Potential health problems can be flagged for the right medical professionals. Unnecessary readmissions can be avoided. This kind of care can actually lower costs, bring in new revenue and meet the needs of the aging population.  

Embracing the Brave New Home-Care World

Above, we questioned whether or not more people and funds in MA plans and more reimbursable services really is a winning combination. The answer – for patients and providers alike – is yes, but only if health systems prepare. Health systems will have to embrace the task ahead, finding the right partners and strategies to utilize home care services in 2019 and beyond. But with post-acute patients able to live more comfortable, better-monitored lives at home, we know it will be worth it.  CMS policy changes dramatically impact health plans, too. See where the conversation goes.