More Payers Adding In-Home Care, Caregiver Support to Medicare Advantage Plans

Becker’s | By Rylee Wilson

More Medicare Advantage plans will offer in-home support services to enrollees in 2023, according to a new report from the Better Medicare Alliance. 

In 2023, 794 plans will offer in-home support, according to the report published Nov. 17 

In-home support services are one of several additional supplemental benefits approved by CMS in 2018. 

Other supplemental benefits include home-based palliative care, adult day health services, therapeutic massage and support for caregivers. A total of 259 plans will offer caregiver support in 2023. 

The number of plans offering at least one supplemental benefit has grown substantially since 2020. For 2023, 1,111 plans will offer supplemental benefits, up from 351 in 2020, according to the report. 

"As seniors contend with rising household costs, their ability to access more benefits that are built into the affordable cost of their Medicare Advantage plan is welcome news," Better Medicare Alliance President and CEO Mary Beth Donahue said in a news release. 

Read the full report here.

Using “Baby Talk” with End of Life Patients

Barbara Karnes

Dear Barbara,  Some seniors seem to respond well to baby-talk. Some absolutely hate it. How do you know when to use baby-talk and when not to?

When to use baby-talk while providing adult end of life care? NEVER. I find it hard to imagine anyone "liking" to be talked to as if they were a child. As end of life professionals we have to carefully walk a line. We are in the tenuous position of caring intimately for adult strangers who often do act as children. Here are some of the guidelines I follow to help me address this challenge.

Baby-talking to an adult, no matter the age or mental condition, can be perceived as disrespectful. Use the adage: “When in doubt: don’t.” No matter a person’s physical or mental condition we need to interact with them with dignity. Baby-talk lacks dignity. Along this same line, consider the importance of displaying courtesy and recognizing patient/caregiver boundaries.

My internal guidance tells me to treat all of my patients and their families in the same manner I would want to be treated if the situation were reversed. Tone of voice, rough touch, external conversation beyond the patient (as if they were not there), impatience, hurriedness, and aloofness all negatively affect the dignity of a person.

I saw a nurse walk into my mother’s room, give her a hug, and say, “Aren’t you the cutest thing I’ve ever seen?” 

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State Resources to Increase Direct Care Worker Wages

The National Governor’s Association (NGA) published a paper examining Medicaid policy vehicles that states can use to increase direct care worker wages. The paper provides a summary of state approaches to increase direct care worker wages with a focus on those that have reporting requirements, enforcement vehicles, or other mechanisms to help ensure funds go to intended recipients working in facility and HCBS settings.

Read the paper at https://www.nga.org/publications/addressing-wages-of-the-direct-care-workforce-through-medicaid-policies/

With Home Health Rule Unveiled, All Eyes are on HHVBP

McKnight's Home Care | By Liza Berger

A big exhale seemed to sound from the industry last week after the release of the final Medicare home health rule. No question the measure was imperfect, but it helps clear the way for firms to make plans and prepare for other regulatory changes. And of the latter, there are some big ones, including the start of the Home Health Value-Based Purchasing (HHVBP) model, which goes live nationally Jan. 1.

Not unlike the home health rule, there is much anticipation for the HHVBP model, which is based on how well an organization ranks compared  to its peers. Under the expanded initiative, home health agencies receive adjustments to their Medicare fee-for-service payments based on their performance against a set of three quality measures relative to their peers’ performance: Data from Outcome and Assessment Information Set (OASIS), completed Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys and claims-based measures.

The Centers for Medicare & Medicaid Services has been bullish on this model ever since it tested it in nine states starting in 2016. The original model resulted in an average of 4.6% improvement in HHAs’ total performance scores and an average savings of $141 million to Medicare. Evaluation of the original model also found reductions in unplanned acute care hospitalizations and skilled nursing facility (SNF) stays, resulting in reductions in inpatient and SNF spending.

Understandably, the home health industry has voiced reservations toward the national expansion of HHVBP. Due to feedback from provider groups such as the National Association for Home Care & Hospice, CMS delayed the start of HHVBP to 2023. In the recent home health rule, CMS established 2022 as the baseline line. 2025 is the first payment year for the program.

The program symbolizes the ethos of healthcare at the moment: paying for value as opposed to volume, focusing on quality and savings, and keeping people out of the hospital. As companies and consultants continue to remind us, if you are not yet on board the value-based care bus, it’s time to purchase a ticket. Learn more about HHVBP and how to prepare for it.