In-Home Care Providers Must Break Through Barriers to Handle More Long-Term Care Volume

Home Health Care News
By Robert Holly | April 25, 2021
 
There are several trends shaping senior care in the United States, with two of the biggest being continued Medicare Advantage (MA) growth and the steady shift of health care into the home.
 
Yet if in-home care operators want to capitalize on those trends, they’ll have to break through traditional payment and operational barriers. That’s particularly true for home-based care entities looking to roll out new care models for patients who would have otherwise gone to skilled nursing facilities (SNFs).
 
The “SNF-at-home concept” has gained a lot of traction in the wake of the COVID-19 pandemic, but there are still plenty of questions left to answer, according to Anne Tumlinson, founder and CEO of the Washington, D.C.-based ATI Advisory.
 
“I think there’s a limit to what can be done in a home setting, and I worry about caregivers who are not really prepared to bring somebody home,” Tumlinson said at the 2021 Navigator Leadership Summit. “Whatever this model is, it’d better be robust.”
 
On the payment front, breaking through barriers means figuring out ways to make managed care work for providers. Despite steady MA growth, most home health organizations still lean on fee-for-service Medicare, while home care agencies largely remain stuck in the private-pay world.
 
About 43% of the nearly 63 million people eligible for Medicare enrolled in an MA plan for 2021. Looking ahead, MA enrollment is projected to clear 51% by 2025, potentially hitting 64% by the end of 2028.
 
“If your organization does not have a Medicare Advantage strategy that goes beyond just arguing over contracts, you need one,” said Tumlinson, who was speaking to SNF operators and in-home care executives alike.

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