In The News

We Need To Go Where The Patients Are’: How Home Health Agencies Are Adjusting To Medicare Advantage

Home Health Care News / By Patrick Filbin

Medicare Advantage (MA) enrollment has been on a steady climb over the last two decades. As such, home health agencies have started to adjust operations to better fit the payer landscape in the future, and not just now.

Agencies in states like Michigan, Hawaii and Alabama have already had to do that — and those transitions haven’t been seamless.

Cleamon Moorer Jr., the president and CEO of the Detroit-based American Advantage Home Care, has been molding his company’s strategy around one of the greatest NBA point guards of all time.

“We’re understanding that we need to take a lead position and meet patients where they’re going,” Moorer told Home Health Care News. “It’s like the ‘80s Lakers with Magic Johnson. He threw the ball where Worthy was going to be, not where he was at. We need to go where the patients are going to be.”

American Advantage Home Care provides skilled nursing, rehab and specialty care services. Currently, the company serves seven counties in the Southeast Michigan area and has a census of 200 patients.

Changing of the tides

In 2023, 30.8 million people were listed as enrollees in a Medicare Advantage plan — which made up 51% of the eligible Medicare population — and $454 billion (or 54%) of total federal Medicare spending, according to KFF.

The share of Medicare beneficiaries enrolled in Medicare Advantage varies widely across states and counties, however.
Providers are concerned about MA plans’ reimbursement rates for home health services. Meanwhile, patients have some reason to be concerned over the home health access they’ll have underneath an MA plan.

“One concern that certainly comes up is that one in 10 Medicare Advantage patients say they have trouble accessing needed care,” Jennifer Schiller, executive director at the Research Institute for Home Care (RIHC), told HHCN. “It’s a coverage [issue] — but I think everybody is constantly aware of the fact that Medicare Advantage is not going anywhere.”
The tides have already started to shift in favor of MA.
Enrollment in MA has seen gradual increases (8% in both 2021 and 2022) and there is no sign of it slowing down.

“I think you’re going to see some more changes — especially over the next few years with various regulations that may impact who is using home health and who is using Medicare Advantage,” Schiller said.

In order to capitalize on that shift – or survive it – home health providers have had to adjust.

Challenges in MA…

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Long-Term Services and Supports (LTSS) Provisional Provider Payments (3Ps)

Long-Term Services and Supports (LTSS) providers are experiencing an increase in claim denials as a result of financial eligibility determination delays, and delays in functional eligibility assessments. The Department of Health Care Policy & Financing (HCPF) has been notified of these issues, as agencies and providers are unable to carry the unpaid claims balance within their existing resources. Some agencies have reported having to limit services, deny accepting new members, or even terminate staff to remain solvent.

HCPF wants to ensure our most vulnerable members continue receiving the support necessary within their communities by mitigating major financial stressors that some LTSS providers are experiencing, which are threatening their solvency or ability to provide service continuity. Therefore, the Department will provide provisional payments in the form of short-term advances to providers that demonstrate the greatest need. HCPF is issuing the LTSS Provisional Provider Payments Request for Application (RFA) to solicit applications from eligible providers. 

PLEASE NOTE: Providers receiving the provisional payment must continue to submit claims and rework denied claims, as normal.

Visit the following URL to learn more or to apply. https://hcpf.colorado.gov/resources-hcbs-providers#3Ps

If you have any questions, please email [email protected].

 

Litter Publications

Colorado employers face additional requirements as of January 1, 2024 to comply with the amendments to Colorado’s Equal Pay for Equal Work Act, which originally took effect in 2021. Most notably, employers will be required to put application deadlines in their external job postings and internal promotional notices. Within 30 days of every hire or promotion company-wide, employers will be required to notify any Colorado employee with whom the selected candidate will regularly work of the new hire or promotion. Employers also must inform employees in positions with a defined, objective career progression of the requirements for advancement and what their pay will be if they advance. The Colorado Department of Labor and Employment has issued final regulations and a new Interpretive Notice & Formal Opinion # 9A detailing the agency’s view of the amendments’ requirements.

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Survival Instincts, Inevitable Tailwinds Will Guide Home-Based Care Providers Through Current Tough Times

Home Health Care News | By Andrew Donlan
 
There’s a confusing outlook right now for both providers of home care and home health care. More value, worth and attention is being placed on those respective industries than ever. But, all the while, providers are facing some of their toughest challenges as 2024 nears.
 
The attention being placed on home-based care is not leading to a windfall for them. Increased awareness and attention on an industry generally means its operators stand to benefit. That has not been the case for most thus far.
 
In 2020, that’s what many of us expected, even with an acute pandemic and staffing shortage to get through.
 
Instead, longtime providers with the sense to see home care’s value years before it was widely popularized are handcuffed by inflation, rate cuts and internal operational challenges.
But their leaders, front-line workers and back-office staff would be wise to keep their heads up.
Demand will continue increasing for the foreseeable future. And, though there’s always been ebbs and flows in the home-based care business, providers are now dealing with those ebbs and flows from a much more advantageous position than they were in years past.
 
When Bo Schembeckler took over Michigan’s football program – during a period of turmoil in the late 1960s – he coined a phrase as players were deciding whether to stay and put in the work under a new regime or, alternatively, to quit or leave.
 
“Those who stay will be champions.”…

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Home Care May Have Reached Its ‘Tipping Point’ With Billing Rates

Home Health Care News | By Joyce Famakinwa

As home care leaders begin to strategize for 2024, part of the process will be identifying the challenges they believe will be main characters next year.

Oftentimes, home care leaders will point to labor as the biggest challenge in the space.

While labor is and will continue to be an issue, there are also other obstacles that are top of mind for many home care leaders, such as regulatory challenges.

Though the majority of Home Helpers’ business is private-pay, the company has experience working with third-party payer sources as well. President and CEO Emma Dickison advises companies that are working in this space to prepare themselves for problems derived from regulation.

“[Regulatory challenges] are always existing, it doesn’t matter which administration,” she said during a recent Home Health Care News webinar. “There are always regulatory challenges, reimbursement discussions and considerations for anyone who is doing work with third-party payer sources.”

One 2023 challenge that industry insiders believe will follow providers into 2024 is client retention.

This is because of the cost of doing business. And, as a result, the price tag attached to care billing rates. Daniel Gottschalk, co-CEO of Family Tree Private Care, thinks that the home care industry has reached its tipping point.

“We’ve probably reached the tipping point of what consumers can actually bear, before they can just say, ‘Hey, enough’s enough, I can’t afford this option anymore,’” he said during the webinar…

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