Home care providers have the potential to impact a greater number of patients, enhance health outcomes, and promote health equity by capitalizing on opportunities within Medicare Advantage (MA) plans. The growing prevalence of MA plans offers home care providers various tools to attract more patients, with the Value-Based Insurance Design (VBID) model identified as an opportunity in a HealthAffairs report. This model provides MA organizations with strategies to expand their client base and reduce costs by utilizing broader "targeting criteria," such as frailty. The report emphasizes that relying solely on claims-based diagnosis criteria may overlook a significant portion of vulnerable individuals lacking the necessary medical claims to support their need for home care.
HCAOA encourages all providers considering the Guiding an Improved Dementia Experience (GUIDE) Model to thoroughly assess its financial feasibility.
It is crucial for home care providers to carefully evaluate the associated expenses tied to participating in the GUIDE Model. This includes the costs of providing in-home respite care and conducting in-person face-to-face live assessments, both mandated components of the GUIDE Model. Furthermore, assessing the financial implications helps home care providers determine whether the GUIDE Model allows for profitability under the payment rates set by the Center for Medicare & Medicaid Services (CMS). This evaluation is critical in determining if implementing the GUIDE Model allows your business to meet its financial goals and is sustainable for your home care agency.
According to a recent article in Home Health Care News, the payer source most likely to dictate the future of home-based care providers is Medicare Advantage (MA), even though plans’ in-home supplemental benefit offerings will take a dip for the first time in 2024. In-home support services (IHSS), which offer an MA entry point for home care providers, grew rapidly from 2020-2023, with the amount of plans offering them growing from 283 to 1,308. In 2024, though, only 867 plans will be offering IHSS, according to the research and advisory firm ATI Advisory.
In a recent policy report, the Better Medicare Alliance (BMA) recommended a set of solutions aimed at enhancing Medicare Advantage for beneficiaries and the broader Medicare program. A critical aspect of these proposed solutions is ensuring a stable payment environment to maintain affordable, high-quality care for beneficiaries and enable innovation in benefit design and care delivery. This stability is crucial, given the ongoing regulatory changes in Medicare Advantage.
On October 10, it was announced all 10 drug companies selected for Medicare Drug Pricing Negotiations Program'sfirst cycle have opted to participate. These companies manufacture some of the most expensive and commonly used prescription drugs. These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, representing about 20% of the total Part D gross covered prescription drug costs between June 1, 2022, and May 31, 2023. Medicare enrollees taking these 10 drugs paid a total of $3.4 billion in out-of-pocket costs in 2022.
The Better Medicare Alliance released its 2023 State of Medicare Advantage Report, which shows record-setting enrollment in Medicare Advantage plans. The report highlights several key findings, including the fact that in-home support services provided by Medicare Advantage plans increased 50% between 2022 and 2023. The average monthly premium for Medicare Advantage beneficiaries in 2023 is at a 16-year low of $18. Beneficiaries report spending significantly less on out-of-pocket costs and premiums annually, resulting in $2,400 in savings, which amounts to 44% less than other Medicare options. Medicare Advantage offers substantial value to both beneficiaries and the federal government, covering all Medicare-covered services for 24% less than Fee-For-Service (FFS) Medicare. Additionally, 95% of beneficiaries are highly satisfied with their coverage. Between 2022 and 2023, in-home support services increased 50%.
AARP's Long-Term Services and Supports (LTSS) 2023 State Scorecard Report was just released and reveals significant gaps in the care provided to older adults and individuals with disabilities in the United States. Although there has been some overall progress compared to the 2020 update, every state still has areas that require improvement.
Choices for Increased Mobility Act of 2023 H.R. 5371 is designed to enhance patient access to a wider range of wheelchairs. It allows for code upgrades for titanium and carbon fiber wheelchairs under Medicare. This legislation seeks to offer wheelchair users a choice of products that align with their medical and lifestyle needs and remove financial barriers that have prevented some Medicare beneficiaries from accessing titanium and carbon fiber mobility solutions. The bill has been introduced in the House and referred to the Committee on Energy and Commerce as well as the Committee on Ways and Means.
The U.S. Department of Health and Human Services (HHS) has successfully reenrolled nearly half a million children and families in Medicaid and Children’s Health Insurance (CHIP) coverage, fixing an error that was causing improper disenrollment. The Centers for Medicare & Medicaid Services (CMS) identified a state systems issue that was improperly disenrolling individuals, even when they remained eligible based on available information. CMS stated that measures were in place that would prevent further improper disenrollments.
Last week, ATI Advisory, LTQA, and the SCAN Foundation released a report analyzing the variability in Medicare Advantage non-medical supplemental benefit offerings by geography and metro/non-metro areas. The goal of the analysis is to expand the stakeholder understanding of benefit offerings across the country. Included in the Executive Summary of the report is the most-commonly offered nonmedical benefits in metropolitan counties, which is Food & Produce (13 plans), while In-Home Support Services (IHSS) is the most common in micropolitan (8 plans) and rural counties (6 plans).
HCAOA has received member inquiries regarding CMS’ GUIDE initiative to improve the quality of life for people living with dementia. Home care organizations currently providing care to people with dementia have expressed an interest in participating in the CMS GUIDE Model, which will offer a standard approach to care, including 24/7 access to a support line, as well as caregiver training, education, and support services. This standard approach will allow people living with dementia to remain safely in their homes for longer by preventing or delaying nursing home placement and improving the quality of life for both people living with dementia and their unpaid caregivers.
An article entitled, “Price of elder care soars as demand increases, baby boomers age,” was published on TheHill.com on August 13, 2023. The article discusses how the cost of caring for aging or ailing family members in the U.S. has risen dramatically in recent years in nursing homes, assisted living facilities, and adult day centers. With insufficient support from programs like Medicare and Medicaid, many family caregivers are forced to deplete their limited funds to cover expenses.
CMS announced it is addressing a data breach that occurred in Progress Software's MOVEit Transfer software on the corporate network of Maximus Federal Services, Inc. a contractor to the Medicare program. The breach involved personally identifiable information (PII) and protected health information (PHI) of Medicare beneficiaries. HHS and CMS confirm that no systems belonging to them were impacted by the breach. Letters are being sent to potentially affected individuals, notifying them of the breach and explaining the steps being taken in response. It is estimated that around 612,000 current Medicare beneficiaries may have been affected.
ATI Advisory Releases New Analysis Comparing Demographics and Characteristics of Medicare Advantage and FFS Medicare Beneficiaries
ATI Advisory recently released an analysis, in collaboration with the Better Medicare Alliance, demonstrating the impact of Medicare Advantage (MA) in addressing disparities among underserved communities. The study reveals a noteworthy trend, as Black and Asian Medicare-eligible beneficiaries exhibit a significantly higher preference for MA over Fee-for-Service (FFS) Medicare. This analysis illustrates the experiences of Medicare beneficiaries across different racial and ethnic backgrounds, shedding light on disparities and health equity opportunities. This research builds upon a Harvard Medical School and Inovalon study, emphasizing MA's role in serving socioeconomically disadvantaged demographics.