In April, the Centers for Medicare & Medicaid Services (CMS) finalized a rule allowing insurers to offer chronically ill Medicare Advantage (MA) members tailored supplemental benefits. Beginning in 2019, the rule explicitly opens up the opportunity for health plans to integrate home care into the home setting. By formally integrating  non-medical caregiver services into the broader healthcare delivery system these benefit expansions will dramatically improve care and enable value-based care efforts system-wide.

With the MA enrollment period for 2019 having opened October 15, payers have already finalized their supplemental benefits package. While payers may have added home care as a reimbursable service for members, the real impact on health outcomes and costs will become more visible in the coming months. Here are the ways plans can maximize the supplemental benefits, specifically non-medical home care services.


Advance Value-based Care

Industry wisdom tells payers that healthcare services are moving away from hospitals. More and more, providers are focusing on patients in-between episodes of care.

Naturally, much of that time is spent in the home. Traditionally, plans rely on notes from clinical encounters to learn about the health and well-being of members. Integrating home care services changes that paradigm. Getting an insider’s view into a patient’s environment reveals an important and more complete story regarding an individual’s health. An in-home caregiver who is a consistent presence in the home is able to identify and document changes – big and small – up close, noting potential indicators of a person’s improving or declining health status.

Using observation, in-home caregivers pick up on the habits and nuances that can elude clinicians who have 15 minute visits and lack an intimate view into the patient’s living arrangements. With open and integrated communication, the in-home caregiver is able to share these insights with payers. This deeper view into their member population gives payers the opportunity to strengthen and advance value-based care efforts.


Digitize and Build Historical Data

Certain pockets of healthcare are still playing catch up in the digital age. In the home care space, it doesn’t have to be that way.

Tech-enabled platforms are blossoming and maturing in the home care sector. CareLinx is able to capture real-time patient data to generate actionable insights. For example, members at an elevated risk are identified through information, such as medication reconciliation, weight, mental health, and other relevant health data. This is incredibly important as payers build relationships with members overtime. In the home, caregivers can closely observe, document, and build out accurate real time patient data.

This data can be used as benchmarks as well as for searchable health history as the patient progresses. If a patient’s health status begins to change, the CareLinx platform enables ongoing information from the home to inform payers and health systems to help prevent unnecessary readmissions. In addition, as payers collect more data on patients within a population, they can assess and review a large swath of data across members in the region. This can lead to insights regarding the health of not just a singular patient but an entire community. This equates to long-term and sustainable improvements in health and cost.


Develop Trust with Members and Think for Scale

It’s no secret that patients can be distrustful of the healthcare system, especially payers. Home care services provide a bridge to forming a strong and loyal relationship with members as caregivers and patients get to know each other. Offering valuable services and a consistent and familiar presence in the home through an in-home worker can earn trust for payers. With familiarity comes comfort. With comfort comes loyalty, making members averse to shopping around for a new plan because patients will be delighted by and depend on the new home care services.

Payers must use this long-term thinking to develop their home care strategy when looking for a partner – a strategy with increasing importance. MA currently claims more than a third of eligible members, and that number is only expected to grow.

As the federal government expands and integrates home care supplemental benefits, it will be important for health plans to partner with a tech-enabled partner that can adapt and scale for long-term sustainability. CareLinx is optimized and poised to deliver these benefits to payers.

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