During the Coronavirus pandemic, the Centers for Medicare and Medicaid Services (CMS) has taken unprecedented action to expand telehealth for Medicare beneficiaries. Since people were advised to stay at home to reduce risk of exposure of COVID-19, there was an urgency to increase access to telehealth services to help people who need routine care and allow beneficiaries to remain in their homes. Early CMS data have shown telehealth to be an effective way for people to access health care safely during the COVID-19 pandemic, whether it’s getting a prescription refilled, managing chronic conditions, or obtaining mental health counseling.
Today, we share data highlighting the impact of telehealth on beneficiary access. We also discuss how we are using this information to assess whether these expanded telehealth policies should remain in place beyond the COVID-19 public health emergency.
Telemedicine—which includes telehealth and other virtual services—allows patients to visit with clinicians remotely using virtual technology. Innovative uses of this kind of technology in the provision of health care are increasing with advances in telehealth platforms and remote patient monitoring technology. New mobile health apps and wearable monitoring devices help track a patient’s vitals, provide alerts about needed care, and help patients access their physician. CMS has long prioritized telemedicine innovation, but COVID-19’s emergence in the U.S. prompted us to drastically accelerate our efforts.
On March 13, 2020, President Trump made an emergency declaration under the Stafford Act and the National Emergencies Act, empowering CMS to issue waivers to Medicare program requirements to support health care providers and patients during the pandemic. One of the first actions CMS took under that authority was to expand Medicare telehealth on March 17, 2020, allowing all beneficiaries to receive telehealth in any location, including their homes. Subsequently, CMS announced additional temporary rules and waivers to expand the scope of Medicare telehealth services, making it easier for more types of health care providers to offer a wider range of telehealth services to beneficiaries across the country. CMS observed immediate, dramatic increases in telehealth services.
With these transformative changes unleashed over the last several months, it’s hard to imagine merely reverting to the way things were before. As the country re-opens, CMS is reviewing the flexibilities the administration has introduced and their early impact on Medicare beneficiaries to inform whether these changes should be made a permanent part of the Medicare program.
CMS Actions To Expand Telemedicine Before COVID-19
By law, Medicare can only pay for most telehealth services in limited circumstances: when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the telehealth service. A telehealth service must use an interactive audio and video telecommunications system that permits real-time communication between the distant site practitioner who is remotely furnishing the service—such as a physician, nurse practitioner or physician assistant—and the patient at a local medical facility.
The Trump Administration recognized the value of telemedicine for patients and health care providers long before the pandemic, as part of CMS’s Fostering Innovation Strategic Initiative, the agency’s comprehensive strategy to improve patients’ access to emerging technologies. That’s why over the last three years CMS made several changes to improve access to virtual care. We expanded the services that can be delivered via telehealth, adding services such as wellness visits that require additional time for complex patients and care for patients experiencing a stroke or with End Stage Renal Disease.
In 2019, Medicare started paying for brief communications or Virtual Check-Ins, which are different from traditional Medicare telehealth visits as they are brief patient-initiated communications with a health care practitioner and not limited to patients residing in rural areas. Medicare also started paying for similar virtual communications with clinicians at Rural Health Clinics and Federally Qualified Health Centers, expanding access to care for patients in underserved rural areas.
And starting in 2020, Medicare separately has paid clinicians for e-visits, which are non-face-to-face, patient-initiated communications through an online patient portal. These types of services don’t require Medicare patients to go to the doctor’s office and are available in all types of locations including the patient’s home, and in all areas of the country (not just rural areas). Beneficiaries need to have an established or existing relationship with their health care provider to get these virtual services.
Similarly, CMS implemented statutory changes enacted by Congress so that Medicare Advantage (MA) plans have the flexibility to offer innovative telehealth services as part of their basic benefit, expanding access to the latest telehealth technologies for MA enrollees. In 2020, over half of all plans are offering these additional telehealth benefits, reaching approximately up to13.7 million Medicare Advantage enrollees.
Expanding Telemedicine For Medicare Beneficiaries During The COVID-19 Outbreak
CMS’s efforts to expand telehealth prior to the COVID-19 public health emergency served as a strong foundation for action in the early days of the pandemic. One of the first steps CMS took in response to the COVID-19 public health emergency was to temporarily expand the scope of Medicare telehealth to allow Medicare beneficiaries across the country—not just in rural areas—to receive telehealth services from any location, including their homes. CMS also added 135 allowable services, more than doubling the number of services that beneficiaries could receive via telehealth. Examples include emergency department visits, initial nursing facility and discharge visits, home visits, and physical, occupational and speech therapy services. Medicare also ensured that health care providers like physicians were paid for these telehealth services at the same payment rate as they would receive for in-person services. Additionally, CMS is allowing telehealth technology to fulfill many requirements for clinicians to see their patients face-to-face in different health care settings, including inpatient rehabilitation facilities, hospice, and home health.
CMS has temporarily expanded the types of health care providers that can offer telehealth to broaden patient access to care. Outside of the public health emergency, only doctors, nurse practitioners, physician assistants, and certain other types of practitioners could deliver telehealth services. During the emergency, a wider range of practitioners can provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists. Additionally, for the first time, through temporary authority added by the CARES Act, CMS is able to pay Rural Health Clinics and Federally Qualified Health Centers to provide telehealth services, giving Medicare beneficiaries located in rural and other medically underserved areas more options to access care from their home without having to travel.
The Trump Administration has also removed other barriers that may limit beneficiary access to telehealth services. Usually, interactive audio-video technology is required for telehealth visits. This can be a challenge for beneficiaries; often, they either don’t have access to the technology or choose not to use it even if offered by their practitioner. At the beginning of the public health emergency, the Department of Health and Human Services (HHS) Office of Civil Rights announced that it would exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the emergency. Soon after, CMS went even further to eliminate these barriers by paying for certain telephone evaluation and management visits and behavioral health services, and paying practitioners at the same rate as similar in-person services.
In addition, HHS Office of Inspector General announced that it would not enforce requirements for practitioners to collect copayments from patients for these kinds of services.
Unprecedented Increases In Telemedicine
With wide-ranging telemedicine flexibilities, there has been a surge in the number of beneficiaries getting telemedicine services. Before the public health emergency, approximately 13,000 beneficiaries in fee-for-service (FFS) Medicare received telemedicine in a week. In the last week of April, nearly 1.7 million beneficiaries received telehealth services.
In total, over 9 million beneficiaries have received a telehealth service during the public health emergency, mid-March through mid-June. Specifically, data points presented in this section of the post are from internal CMS analysis of Medicare FFS claims data from March 17through June 13, 2020 (using data processed through June 19, 2020). Telemedicine services include services on the Medicare telehealth list including audio-only visits, as well as virtual check-ins and e-visits.
According to Medicare FFS claims data, beneficiaries, regardless of whether they live in a rural or urban area, are seeking care during the pandemic through telemedicine services. In rural areas, 22 percent of beneficiaries used telehealth services, and 30 percent of beneficiaries in urban areas did so. There has been regional variation in use of telemedicine during the pandemic. For example, beneficiaries in northeastern states—New Jersey, Connecticut, Maryland, Delaware, Rhode Island and Massachusetts—have a higher percentage of telemedicine services (over 35 percent of beneficiaries in those states received a telehealth service) compared to those in states in the north central part of the country—South Dakota, Nebraska, North Dakota, Montana and Idaho (less than 17 percent of beneficiaries in those states received a telehealth service). The regional variation could be due to the extent to which health care providers in those states offered telemedicine services and whether patients sought out care via that option.
Beneficiaries are getting care through telemedicine during the pandemic at similar rates across demographics. For example, 30 percent of female beneficiaries and 25 percent of male beneficiaries have received telemedicine services during the COVID-19 public health emergency to date. Across all age groups, 25-34 percent of beneficiaries have received a telemedicine service (34 percent among beneficiaries below the age of 65, 25 percent among beneficiaries between ages 65-74, 29 percent among beneficiaries between ages 75-84, and 28 percent among beneficiaries older than 85). There are also no significant differences by race or ethnicity among beneficiaries who received telemedicine services (25 percent among Asians, 29 percent among Blacks, 27 percent among Hispanics, 28 percent among Whites, and 26 percent among others).
Dually eligible beneficiaries (low-income beneficiaries that qualify for both Medicare and Medicaid) have had higher rates of telemedicine use: 34 percent of dually eligible beneficiaries have had a telemedicine service, compared to 26 percent of Medicare-only beneficiaries. Even among dually eligible beneficiaries, there are no significant differences across race or ethnicity groups (30 percent among Asians, 34 percent among Blacks, 33 percent among Hispanics, 35 percent among Whites, and 31 percent among others).
Evaluation and management (E/M) visits, or office visits, have been the most common form of telehealth, with nearly 5.8 million beneficiaries receiving an E/M telehealth visit since the public health emergency started. Additionally, 38 percent of beneficiaries who had an E/M visit furnished during the public health emergency did so via telehealth. Another area where telehealth has been used frequently has been mental health services with a psychiatrist or psychologist: approximately 460,000 beneficiaries (or 60 percent) receiving this care through telehealth. Telehealth for mental health care is showing great promise for our Medicare beneficiary population, who may otherwise have felt stigmatized seeking out care in-person.
Additionally, during the pandemic, CMS expanded the availability of telehealth services in other settings of care, including nursing homes, where beneficiaries may be particularly vulnerable. We found that 26 percent of beneficiaries who received nursing home visits did so by telehealth. Lastly, nearly 1.5 million beneficiaries have been able to access preventive health services during this time, and 19 percent of those beneficiaries received such services by telehealth.
The use of audio-only telehealth services has also been shown to be helpful for the Medicare population during the public health emergency, as many patients may not have access to or feel comfortable using video technology. Over 3 million beneficiaries have received telehealth services via traditional telephone. That means nearly one-third of beneficiaries that received a telemedicine service did so using audio-only telephone technology.
The claims data are preliminary since health care providers have 12 months after they furnish a service to submit their claims to CMS. But as exhibit 1 shows, the early data show a dramatically accelerated adoption of telehealth in a matter of months, which warrants consideration of which telehealth flexibilities should become a permanent part of the Medicare program.
Exhibit 1: Number of Medicare FFS beneficiaries receiving telemedicine per week
Source: Internal CMS analysis of Medicare FFS claims data, March 17, 2020 through June 13, 2020(using data processed through June, 19, 2020) Notes: Telemedicine is defined to include services on the Medicare telehealth list including audio-only visits, as well as virtual check-ins and e-visits.
Telehealth will never replace the gold-standard, in-person care. However, telehealth serves as an additional access point for patients, providing convenient care from their doctor and health care team and leveraging innovative technologies that could improve health outcomes and reduce overall health care spending. The rapid explosion in the number of telehealth visits has transformed the health care delivery system, raising the question of whether returning to the status quo turns back the clock on innovation.
The data have shown that telehealth can be an important source of care across the country, not just for those living in rural areas. Additionally, the immediate uptake in telehealth demonstrates the agility of the health care system to quickly scale up telehealth services, so that health care providers can safely take care of their patients while avoiding unnecessary exposure to the virus.
In light of our new experience with telehealth during this pandemic, CMS is reviewing the temporary changes we made and assessing which of these flexibilities should be made permanent through regulatory action. As part of our review, we are looking at the impact these changes have had on access to care, health outcomes, Medicare spending, and impact on the health care delivery system itself.
First, it is important to assess whether the mode of telehealth service delivery is clinically appropriate and safe for patients, as compared to an in-person visit. For example, during the public health emergency, CMS expanded certain telemedicine services to both new and established patients, where previously those services were limited to patients who had an established relationship with the practitioner. CMS took this action to make these services as widely available as possible given the need to reduce exposure risks for practitioners and patients. As the health care system enters a new normal, it is important to consider whether allowing people with particularly acute needs to be seen by a clinician for the first time via telemedicine, instead of in-person, will result in the best possible outcomes.
Second, we need to assess the Medicare payment rates for telehealth services. During the public health emergency, Medicare paid the same rate for a telehealth visit as it would have paid for an in-person visit, given the unique circumstances of the pandemic. Outside the pandemic, by law Medicare usually pays for telehealth services at rates similar to what professionals are paid in the hospital setting for similar services. Further analysis could be done to determine the level of resources involved in telehealth visits outside of a public health emergency, and to inform the extent to which payment rate adjustments might need to be made. For example, supply costs that are typically needed to enable safe in-person care (for, e.g., patient gowns, cleaning, or disinfectants) and built into the in-person payment rate are not needed in a telehealth visit. On the other hand, there are new processes that clinicians must create for telehealth visits, with associated costs.
Lastly, it is vital that beneficiaries and taxpayer dollars are protected from unscrupulous actors. As more health care providers use telehealth to treat beneficiaries, CMS is examining our data from many angles. We are monitoring program integrity implications such as practitioners who may be offering shorter telehealth visits with patients to maximize payment, or billing more visits than are possible in a day. We know the path forward to expanding telehealth relies on CMS addressing the potential for fraud and abuse in telehealth, as we do with all services.
During these unprecedented times, telemedicine has proven to be a lifeline for health care providers and patients. The rapid adoption of telemedicine among providers and patients has shown that telehealth is here to stay. CMS remains committed to ensuring that the government supports innovation in telehealth that leverages modern technology to enhance patient experience, providing more accessible care.
By Seema Verma | July 15, 2020
Source: Health Affairs
M&Y Care has earned the 2019 SHPBestTM “Premier Performer” Patient Satisfaction Award
M&Y Care has been recognized by Strategic Healthcare Programs (SHP) as a “Premier Performer” for achieving an overall patient satisfaction score that ranked in the top 5% of all eligible SHP clients for the 2019 calendar year.
The annual SHPBest™ award program was created to acknowledge home health agencies that consistently provide high quality service to their patients. The 2019 award recipients were determined by reviewing and ranking the overall satisfaction score for more than 3,000 home health providers. With the largest HHCAHPS benchmark in the nation, SHP is in a unique position to identify and recognize organizations that have made patient satisfaction a priority and have been rewarded for their efforts with high marks on the HHCAHPS survey.
“SHP is proud to present the SHPBest awards to our top-performing customers. We commend these organizations for their continuous focus on delivering the highest quality of care to their patients”, said Rob Paulsson, President of SHP.
The infection began with a dry cough that Michael Novielli couldn’t shake.
He soon developed fatigue, aches and a low fever.
As a 71-year-old with underlying health conditions, living on Long Island near the American epicenter of the COVID-19 outbreak, Novielli wasn’t taking any chances. So as his symptoms worsened, he went to the hospital, where he was diagnosed with COVID-19.
“I had never felt this sick my whole life,” he said.
Novielli spent four days in the hospital before he was sent back home. “I was going to wait it out,” he said. “I thought I could get rid of it at home.”
As a precaution, Novielli’s VA providers placed him on a telehealth program to monitor his symptoms at home. Once his recovery took a turn for the worse, Novielli says the VA telehealth program saved his life.
“The Best Move I Ever Made”
Michael Novielli served as a U.S. Marine during the late 1960s. He developed chronic lymphocytic leukemia after exposure to Agent Orange in Vietnam. Later in life, he was also diagnosed with diabetes.
Novielli’s care team at the VA Medical Center in Northport, New York, first suggested Remote Patient Monitoring – Home Telehealth (RPM-HT) about five years ago. They gave Novielli a blood pressure monitor that he could use at home to keep track of his health.
“It was the best move I ever made,” said Novielli. “For me, my blood pressure is very important, and using telehealth, they are able to monitor that from home.”
After being hospitalized with COVID-19, Novielli was happy to use RPM-HT to track his recovery once he returned home on April 3. Through the COVID-19 RPM-HT program, Novielli began sharing his temperature, oxygen levels, and heart rate every day with the VA telehealth team at the Northport VAMC.
On April 22, more than two weeks after Novielli was discharged from the hospital, Marjorie Rogers, a registered nurse with 14 years’ experience with VA, noticed something unusual in Novielli’s symptoms. Although his temperature and oxygen levels were normal, Novielli’s heart rate was elevated.
Rogers called Novielli immediately. “She said, ‘Your heart rate is up. Something’s definitely wrong. Go to emergency right away,’” Novielli said.
When Novielli arrived back at the hospital, doctors found that COVID-19 had caused fluid to build up in his lungs. Novielli had developed pneumonia.
This time, Novielli was in the hospital for almost two weeks. He was on oxygen and antibiotics, felt weak and tired, and lost 40 pounds. But after 13 days, he said, “The monster had left me.”
“Marjorie saved my life,” said Novielli. “If I wasn’t on the telehealth, I would have stayed home with the pneumonia, and who knows what would have happened.”
Using Telehealth To Stop the Spread
For VA providers like Marjorie Rogers, RPM-HT has been an important tool in fighting the spread of COVID-19 at the Northport VA.
“Because it’s a new disease, there is so much we don’t understand about it and that we’re learning,” Rogers said. “Through telehealth, we are keeping our Veterans safe from exposure. They’re not going into the VA facilities if they don’t have to, since we’re able to monitor them in their homes.”
Alisa Tribley, a registered nurse who is the Northport telehealth coordinator, said that telehealth has grown to meet the needs of Veterans with COVID-19. She said that at the peak of the local outbreak, over 140 Veterans were enrolled on Northport’s RPM-HT COVID-19 protocol.
“With RPM-HT, we are monitoring mild symptoms that can be managed at home and recognizing if Veterans reach the point where they should go for in-person care,” Tribley said.
Making a difference
Some of the Veterans in Northport are using telehealth for the first time. Tribley said that while it is an adjustment for some, many are appreciative of the added care.
“Veterans are very grateful that they have a health care team member watching over them and being in touch with them on a daily basis,” said Tribley. “It’s very rewarding knowing that you’re making that difference for them.”
Rogers said that she felt honored when Novielli called her to thank her for intervening on his behalf.
“I really felt that his story was a testament to all the VA telehealth coordinators nationwide,” she said. “To hear him say that really gave me a sense of pride that we’re contributing to Veterans health — that we’re helping them stay alive.”
Novielli says he is thankful for all the care he received from the VA telehealth team and at the hospital. When he finally overcame the pneumonia, the health care workers on his floor applauded as he left the hospital. “It’s nice to have people like that take care of you — people who really care,” he said.
Novielli is still being monitored by RPM-HT – but his cough is finally gone, he is off oxygen, and he’s starting to go on walks with his physical therapist. He said that once a COVID-19 vaccine is developed, he wants to visit Europe and go on a cruise with his fiancé.
Novielli said he hopes that his experience encourages his fellow Veterans to take COVID-19 seriously and take advantage of VA telehealth resources.
“Going through something like this makes you feel for other people who weren’t as fortunate,” Novielli said. “I hope it encourages people to take more care, and to have a better outlook on life.”
Taken from Official Blog of the U.S. Department of Veterans Affairs
Posted on Monday, June 22, 2020 9:30 am
Home care agencies have been trying to figure out how to partner with Medicare Advantage (MA) plans since the Centers for Medicare & Medicaid Services (CMS) announced the possibility back in 2018.
Anne Tumlinson, CEO of ATI Advisory, has the answers. She’s an expert on the economics of aging, a panelist at the upcoming Home Health Care News Virtual MA Summit and the latest guest on HHCN’s Disrupt podcast.
In our newest episode of Disrupt, Tumlinson breaks down the MA opportunities for home care providers by the numbers — from the number of plans offering in-home benefits to the financial considerations driving MA decisionmakers. Additionally, she briefs agencies on how the coronavirus is rocking the industry, what providers should say when pitching to plans and why home care’s future in MA is looking especially bright.
To hear that conversation and others, you can subscribe to Disrupt via Apple Podcasts, Google Play Music, SoundCloud or your favorite podcast app.
Tumlinson will dive even deeper into the financial considerations guiding MA decision makers at the Virtual MA Summit, which runs June 24 through 26. You can register here.
Until then, you can catch portions of HHCN’s conversation with Tumlinson below, edited for length and clarity.
HHCN: While many home care agencies want to work with MA plans, only a few are. In 2019, about 3% of MA plans offered in-home support services. Your team released some new data for 2020, pre-coronavirus, but what does that figure look like today?
Tumlinson: Today, there are 223 plans offering the new supplemental benefit in-home support services. That’s the category referring to in-home personal care services.
That is an increase over the previous year, which was only about 80. So the good news is we’re definitely seeing an increase from 2019, when these benefits could first be offered.
At the same time, this is also the first year plans could offer a whole new set of benefits much more focused on social-support needs. They’re called Special Supplemental Benefits for the Chronically Ill (SSBCI). It’s a category that lets plans offer benefits not related to health care at all — food, produce, meal, pest control, transportation, social-needs benefits.
Between the non-medical primarily health-related benefits and new non-medical services, we have 619 plans that are doing one and/or the other. That’s not a high percentage of the about 3,000 or 3,500 plans, but the fact that there are 619 plans doing this at all, to me, is like a small miracle.
Are all of those plans working with home care providers to offer those services?
It varies tremendously.
We’re definitely seeing the approach where somebody in the health plan has reached out specifically to a home care provider in their market — or two or three — to say: “Hey, we want to offer this benefit. Are you guys equipped to deliver it, and can we start to talk about what that relationship would look like?”
It might be a regional plan, like Geisinger or SCAN Health Plan. They want to work with regional local providers with whom they can build long-lasting relationships and can be collaborative to their approach to collecting data and information.
Another model we see [is from] some of the larger insurance companies like Humana (NYSE: HUM), Anthem (NYSE: ANTM) and WellCare (NYSE: WCG).
Some [larger plans] haven’t done anything, really. They just put these benefits in their benefit package, and they haven’t really built out a contracted network yet. It’s still a really immature set of relationships where there’s a lot of floundering around.
Model No. 3 is where there’s an intermediary that’s serving kind of like an aggregator. We have a relationship with a company called healthAlign. A couple health plans have contracted with them to essentially find all of the different home care providers and aggregate them in one platform to play the go-between role in terms of contracting and things like that.
That’s my favorite kind of model.
How has the coronavirus shaken up the MA industry?
It’s a little hard to say right now.
Many MA plans are in this very weird position where their costs are way down for medical care because doctors’ offices and everything else has been closed. They’re kind of sitting there with the pot of money they’re supposed to be spending that they haven’t been able to spend.
Secondly, they’ve been given this incredibly broad flexibility from CMS around these supplemental or non-medical benefits, which previously only a handful of them had been offering as formal benefits.
But now CMS is saying: “If you need to change that in the middle of the year, which is normally not allowed, [you can]. We get it. You did your benefit packages way back before anybody knew what COVID-19 was, and now you’ve got a bunch of people stuck at home, who need things like meals, groceries and in-home support services. We’re going to allow you health plans to make those changes in your benefit packages … so that you can meet your member needs and redirect the resources.”
But the third thing is there’s an enormous amount of uncertainty, so it’s really hard, especially for larger plans, from a financial standpoint, to say, “Let’s start buying in-home support services.”
They don’t know if three or four months from now there’s going to be this huge pent-up demand for all these elective procedures. So there’s some hesitation on their part to jump in with both feet and start paying for things that they haven’t been paying for before.
My opinion is given how long we expect this pandemic to dramatically affect our lives, it’s going to dramatically change the way that MA plans and health care, in general, are delivered — and these flexibilities will be more and more deployed.
It looks really good for home care right now. That is the bottom line.
I know there’s not a lot of data on those mid-year MA flexibilities, but this essentially means that MA plans could be adding new home care benefits right and left right now, right?
This all sounds really good for home care, but I don’t want to sound flippant because I know there are a lot of challenges to delivering home care as a result of the virus. But I think there will be a need.
What other recommendations would you have for providers looking to get involved with MA plans?
You’ve got to attack this in a variety of ways.
Look at the local health plans. Who in your market is a real leader at a community level? It could be a hospital, a health system, a physician group.
I always give the example of Geisinger or SCAN Health Plan. They’re a little bit less bureaucratic, and they’re a lot more focused on meeting the needs of [the] community.
Those are going to be the organizations that are more receptive to working with you. There’s fewer people to deal with, and you can find the decisionmakers and get in front of them.
If you’re part of a national organization, … think about, at your corporate level or at a regional level, what is going to be your strategy or your approach?
You’ve got power in numbers. You’ve got a quasi-network. How do you organize yourself in a way that gives you something to take to those conversations?
Finally, you have to have something to say about who you are when you make that approach, really making sure that you understand what is valuable to these health plans. “How can we as an agency be helpful in delivering [these services]?” And what are the benefits to you in offering them?
On the flip side, what are MA decisionmakers taking into account when they’re creating plans?
It’s a long process in deciding what’s going to go into a benefit package. We’re in June 2020, … and their [plan] decisions are all made for 2021.
In a month or two, if they haven’t already, [plans] are going to start thinking about what’s going to go into their packages for 2022.
How much extra money are they going to have under their bids and how are they going to divide that up? A lot of it goes into what other plans are doing in that market and how they can be competitive.
At the end of the day, what Medicare Advantage plans really want to do is be very, very competitive on enrollment. That’s No. 1. “How can we structure our benefit package to be attractive, both in terms of attracting new members and retaining current members?”
And then, “How can we do this in a way that doesn’t … increase spending in any way, shape or form above and beyond what we estimate it will?” They want to feel comfortable that they know what they’re doing when they price [supplemental benefits].
Finally, they care a lot about what we call coding — information that can help their care managers manage their population better. And then also, you know, what kind of information can help in the coding that they need to get paid well by CMS.
Finances are obviously an important part of the equation. We’ve heard from some providers working with MA plans that the payments they’re getting aren’t always great.
That’s exactly right.
[Imagine] for illustrative purposes every health plan getting $1,000 per member, per month.
Let’s just call that the benchmark right now. Then the plan says, “Hey, I think we can do this for $900 per member per month.”
CMS says: “That’s awesome. Of that difference of $100, you get to take $50 of it and do whatever you want with it.”
Not anything, but all that fun stuff that’s going to help you attract enrollees like lowering the cost of the plan premium, lowering out of pocket costs, offering supplemental benefits.
This is not a lot of money relative to the rest of the spend. Within that, they have to prioritize. This is very hypothetical right now, but there’s really a small amount of dollars available designated for the category that we’re talking about.
In many ways, this opportunity [for home care providers] is more strategic and symbolic than it is financially a big win.
The actuaries have to price the risk. They think, “Hey, how about if we pay $4 for every 15 minutes.” They don’t really know what they’re doing, so the rates are not great. Not always, but in many instances.
The last thing I’ll say about all this is that the policy environment is very fluid right now. This is an election year. We have a huge pandemic going on. Nursing homes are under fire. Medicare’s never been more flexible.
Going into next year maybe, there are going to be some proposals on the table to make the pot of money available for home care from public paying sources bigger because there’s a recognition that people really do need these services to stay home and to stay out of nursing homes.
Overall I’m hopeful that will go up. That’s why it’s so important to strategically position yourself with these payers now.
By Bailey Bryant | June 17, 2020
Source: Home Health Care News
For the first time in our modern history, staying at home has become a “new” normal. And with more than 1.5 million Americans now infected with COVID-19, never before in our lifetime has accessing care in a person’s home been so important.
Smartly, our federal and state policymakers quickly expanded reimbursement for telehealth and removed barriers that have now allowed more providers to care for patients virtually via video and phone, eliminating the risk of COVID-19 exposure during provider visits. But not all care can be provided through telehealth – and we would be shortsighted to not also address the growing need for home-based care.
Long before the COVID-19 emergency, health care policy experts have increasingly recognized the value of home-based health care. A recent AARP survey found that three in four adults 50 years and older would prefer to age in their homes and communities. And a growing body of evidence suggests it is less expensive to deliver care in the home. Indeed, for years we’ve seen hospitalized patients more quickly returning to their homes and communities to heal and recover safely, reducing costs for themselves and the health care system.
Home-based care addresses some of the negative health effects of social isolation and loneliness, which drive poorer health outcomes that annually cost billions of excess health care dollars. According to one study, those experiencing loneliness and social isolation had a more than 60 percent higher risk of developing dementia and a fourfold increase in hospital readmission rates within a year of discharge.
Despite its demonstrated value, our country has yet to fully integrate the support needed for home-based care. Instead, we have a collage of different reimbursement frameworks across state, federal, and private payers.
Traditionally, Medicare has paid only for home caregivers in very limited circumstances. But we’re now seeing small and promising changes. The Medicare Advantage program, for example, now allows plans to offer non-medical care services in the home as supplemental benefits. These benefits can include day care services, in-home support services including meals and support for caregivers.
We have also seen a surge of technologies to enable home-based care. From those receiving home infusion therapies, to home dialysis, to remote patient monitoring, the private sector has stepped up to meet the needs of those wanting to or needing to receive care at home.
Now is the time to expand on these promising changes with a more comprehensive approach to paying for home-based care delivery. With more thoughtful integration of caregiving services and improved care coordination across care settings, including the home, such models can drive down health care costs for patients and the system overall.
Whether caring for those impacted by our current public health crisis, or those who are medically homebound, or those who simply choose to age in place, policymakers should think beyond essential medical services and consider the non-medical drivers of health that are often as essential to good health outcomes. For example, many individuals needing to stay at home are ill-equipped to carry out their own basic needs. Daily tasks — such as getting in and out of a chair or bed, moving about the house, shopping and preparing meals, taking medications properly, bathing and dressing, and cleaning and laundry — can be a struggle for the elderly and those with serious health conditions.
Fortunately, we have millions of home health nurses and caregivers working on the front lines to care for vulnerable adults who should safely remain in their homes during this pandemic and beyond.
These workers are the foot soldiers who perform tasks such as shopping, meal preparation and assisting with mobility and personal care. Well-trained caregivers and nurses, sensitive to the time and place where patients actually live, can more readily identify and address issues that can exacerbate a person’s chronic, complex illness that may not otherwise be visible in a single visit to a traditional health care setting.
As we face record unemployment, federal, state and local policymakers should consider how best to utilize this untapped resource both now and in the future. With the appropriate testing, training, and reimbursement, individuals can have a choice in where they age and receive care.
While keeping people safe and healthy in their homes has always been appealing, now it is imperative. For our most vulnerable individuals — the elderly and those with chronic health conditions – home-based care can save their lives.