For Home Care Providers, There’s Untapped Potential In Long-Term Care Insurance

Home Health Care News / By Andrew Donlan

While Medicare Advantage (MA) has been spotlighted as a potential new source of revenue for home care providers over the last couple of years, long-term care insurance (LTCI) has gone under the radar.
 
Increasingly, home care providers have become bullish on LTCI plans and the untapped opportunities they may offer.
 
“There’s massive potential, and they are trying to tap into it,” The Helper Bees CEO Dr. Char Hu told Home Health Care News.
 
While private pay and Medicaid are generally considered the two main sources of revenue for personal home care providers, long-term care insurance is set up to cover those services at a “sometimes very nice reimbursement rate,” according to Hu.
 
The disconnect tends to be that national health plans are not willing to procure a host of providers to partner with in such a fragmented space. That’s the gap The Helper Bees is trying to fill.
 
Based in Austin, Texas, The Helper Bees is an insurtech company that acts as a liaison between home care providers and health plans. It does so on the MA side – it acquired healthAlign in 2021 – as well as on the LTCI side. The company has raised over $19 million to date.
 
Hu wants to open up opportunity for providers broadly, but especially within LTCI. The company has a proprietary system that helps providers and caregivers find work on a regular basis, and also ensures they’re paid regularly and on time. It has a network of home care providers it works with, both in LTCI and in MA.
 
“The health plans have hired us to be the aggregator and we’ve gone out and built these networks,” Hu said. “Most home care agencies would love to tap into [this]. They just can’t directly through the carrier because it would be impossible from a procurement perspective.”
 
For home health and home care providers, one of the toughest parts about working with health plans has been communication. They often find there’s no good point of communication within the health plan for them, which is to the detriment of both parties.
 
Because The Helper Bees is partnering directly with these plans, and bringing a network of providers along with it, that problem has mostly dissolved. The company has an array of health plan partnerships, and though Hu could not disclose all of them, he did acknowledge it works with “three of the four biggest plans.”
 
“[Within] long-term care insurance, these are people paying premiums, but they’re not using any of their benefits,” Hu said. “As a whole, the claims volume is very small right now, but it’s going to increase at a quadratic rate quickly. You’re starting to see very big carriers, with very smart individuals, getting ahead of this problem – and home care providers and long-term care providers are going to be integral in this.”
 
Some home care providers haven’t explored MA and LTCI because of lower rates and shoddy referral consistency from health plans.
 
Hu says The Helper Bees can offer providers in its network a consistent referral flow, however. Plus, there’s no client acquisition cost for providers.
 
But, more than anything, the value proposition is about revenue diversification. Home care providers across the country are experiencing unprecedented hikes in billing rates, which is shrinking the population that can pay out of pocket for home care long term.
 
A steady stream of revenue from MA or LTCI offers providers a safety net of sorts, as well as an introduction to more senior populations that need home care services.
 
“We want to help home care providers do better business,” Hu said. “We want to help them become more lucrative, we want to help them with their staffing, and we want to help them with diversifying revenue streams. That’s generally what we’re trying to do, and we’re doing that through our partnerships with health plans.”

Parkinson’s Foundation: Community Partners in Parkinson’s Care

What is the program

A program designed to educate and prepare staff to provide better care for people with Parkinson’s disease (PD) who are living in senior care communities or utilizing home care agencies across the country.

Benefits to joining the program

The program provides a full curriculum of Parkinson’s education through virtual and in-person trainings. Utilizing the train-the-trainer model, the membership program educates two or more site champions at each location and provides the necessary tools to educate at least 70% of the staff at their site. The program, formerly known as the Struthers Parkinson’s Care Network, funded by the Edmond J. Safra Foundation, has continued to expand and now includes more than 100 member sites across North America.

Cost to join program*

• Membership for home care agencies: $1,500 (annual fee)
• Membership for senior care communities: $2,750 (annual fee)

*Care communities serving underserved communities should reach out to us to discuss possible discounted rates as from time to time, sponsors will cover these costs.

Steps to join the Program as NEW members

1. Complete new member application (www.parkinson.org/communitypartners)

2. Application is reviewed for acceptance

3. Agreement and Invoice are sent for completion and payment (this triggers the membership cohort, Q1, Q2, Q3, or Q4)

4. Once payment is received, site champions are invited to the virtual training with program details and given access to the online modules

5. Two site champions participate in the training

6. After training, site champions return to work and share materials with colleagues, they (the administrator) work with staff to ensure 70% or more of clinical staff have completed the online modules

7. Once 70% threshold is met and confirmed, member is recognized as part of the program and may advertise their membership

Current members who wish to train new or additional site champions

1. Complete current member application (www.parkinson.org/communitypartners)

2. Application is reviewed for acceptance

3. Person(s) is/are invited to next quarterly training

See Attached Flier

Ask Our Senators to Support Preserving Access to Home Health Act

The Centers for Medicare & Medicaid Services has made drastic cuts to home health that will reach approximately $20 billion in the next ten years. 

Cuts of this magnitude will threaten the ability of nearly 3 million Medicare beneficiaries to receive clinical nursing and therapy care services in the home each year.

Fortunately, Congress is taking action. Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) recently introduced the Preserving Access to Home Health Act (S. 2137) to prevent CMS from implementing these dire cuts.

This legislation is immediately needed to protect the future viability of the Medicare home health program, and we need your help to get this legislation passed. Send an email to your Senators today urging them to support this vital legislation.

Send a Message Now! (Customize or Use the Provided Form Letter)

CMS Home Health Cuts Could Be More Significant Than Originally Estimated, New Analysis Reveals

Home Health Care News | By Robert Holly

If finalized as is, the home health proposed payment rule for next year could lead to larger cuts than originally estimated.
 
That’s according to an analysis from Homecare Homebase (HCHB), which pulled data from its vast customer base, representing nearly 50% of all Medicare-certified home health visits.

Released on June 30, the FY 2024 home health proposed payment rule from the U.S. Centers for Medicare & Medicaid Services (CMS) includes a 3% market-basket update that’s partly offset by a roughly 0.3% downward productivity adjustment. The agency’s plan also includes a 0.2% increase that reflects the effects of a proposed update to the fixed-dollar loss ratio used in determining outlier payments.
 
Added up, those figures produce a 2.9% increase in home health payments for 2024. That positive number, however, is offset by a whopping 5.1% cut from CMS, which believes it has to permanently adjust payments under the Patient-Driven Groupings Model (PDGM) to maintain budget neutrality, as mandated by the Bipartisan Budget Act of 2018.
 
The way the math currently works out, CMS estimates that its proposed payment rule would represent an aggregate cut of 2.2% next year, or about $375 million less compared to 2023 levels.
 
Broadly, CMS says it needs to make permanent adjustments to home health payment mechanics because providers adapted to PDGM in a way that’s different from how the agency assumed providers would behave under the model. Those behaviors are largely related to how agencies document and code for their patients’ functional-impairment levels, their number of clinical comorbidities and more.
 
“In the CY 2023 HH PPS final rule, using CY 2020 and 2021 claims, CMS finalized a methodology for analyzing the differences between assumed versus actual behavior changes on estimated aggregate expenditures and calculated levels of actual and estimated aggregate expenditures,” the agency wrote in a June 30 fact sheet. “Based on analyses of CYs 2020 and 2021 claims data, CMS determined a permanent adjustment was needed.”
 
But after doing its own numbers crunching, HCHB estimates that the 2024 cut could be even greater than 2.2%.
 
“In terms of HCHB’s methodology, as soon as the proposed rule is released, our regulatory and analytics teams immediately begin reviewing every detail of the rule and updating our ongoing models,” HCHB Chief Strategy Officer Scott Pattillo told Home Health Care News in an email. “Once the new model is complete and has been thoroughly tested, we take all the claims for 2023 (year-to-date) and run them through the proposed 2024 model. Then we compare the actual reimbursement in 2023 to the modeled reimbursement for 2024.”
 
After analyzing reimbursement by standard periods, Low Utilization Payment Adjustments (LUPAs), outlier payments, wage-index changes and other factors, HCHB estimates aggregate total home health payments next year could be trimmed by as much as 2.66%.
 
“This year’s results show that, if agencies saw the exact same patients and performed the exact same services, they would be paid 2.66% less for those patients in 2024 than in 2023,” Pattillo explained.
 
While a difference between the CMS and HCHB estimate may seem small, it ultimately could translate into several million dollars of home health payments.
 
Senior Director of Product Management Andy Guarnera and Product Manager Benjamin Hayes, both in the data analytics department of Homecare Homebase, helped spearhead the analysis.
 
Not equal for everyone
 
Pattillo was careful to point out that the proposed payment adjustment for next year wouldn’t be equal for everyone.
 
“Each of our customers has their own unique results,” he said. “While we cannot share the details by agency, we can share some ranges.”
 
Unique to this proposed rule, Pattillo noted, is that every state will see a cut, which hasn’t always been the case. Yet some states will be barely impacted at all, while others could receive an almost 6% cut.
 
“Agency results show a wide range from -6% for a few, to up to a 3.6% increase,” Pattillo said. “The biggest drivers of this variance are case mix and wage index.”
 
Generally, the greatest drivers of this year’s potential cut in terms of real impact are the reduction in standard payment and case mix, which is slightly offset by the increase in outlier revenue.
 
“Based on HCHB’s very large sample, we would expect this -2.66% to be representative of the aggregate impact to the whole industry,” Pattillo said.

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