With the first-ever release of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage (MA) data at the end of April, MA trends from the last decade show these plans are far more popular than expected. The percent of MA plan enrollees has increased from 13% to 33%. During the same timeframe, the government spending on MA plans increased from $77 billion to $200 billion. That’s a dramatic 20% increase in MA enrollment and almost $10 billion more per year over the span of about twelve years.
As the popularity of MA plans expands, so too does the coverage. This data comes on the heels of the CMS official announcement that the benefits health plans can include in their MA policies are changing. Specifically, CMS redefined what “primarily health-related” benefits will mean in 2019. Non-skilled home care, in-home health, and other post-acute care services are rising to the top of this new policy.
Pros and Cons of the Health-Related CMS Policy Changes
When we take a more holistic view, we can see why CMS is making the announcement at this time. The way we think of, interact with, and even talk about healthcare is changing. The shifts in healthcare vernacular are a prime indicator: “health” to “wellness,” “patients” to “consumers,” “treatment” to “prevention.” CMS is taking steps to enable health plans, providers, and others involved in the care continuum, both in healthcare facilities and in the patient’s own home, to meet the growing demand for healthcare focused on more than treating those who are sick.
On the other hand, with that power comes great responsibility. Health plans are already trying to maintain profitability, provide competitive offerings, and keep up with constantly evolving compliance and regulatory systems. To enable the full benefits of home care and begin to address social determinants of health, plans will need to build and maintain adequate networks across multiple locations. This may be something many plans aren’t ready to take on alone.
Health Plans Can (and Should) Prepare for CMS Policy Changes in 2019
Breaking down the facts of the updated CMS policy offers us a clear picture of the direct impacts the new policy will have for health plans. Primarily, health plans will have more billable in-home and post-acute care services and options, meaning costs of readmissions and unnecessary utilization can decrease, but they’ll also be likely to have an increased administrative burden. To make the switch effectively and efficiently, health plans should partner with tech-driven non-skilled home care companies that can ensure ongoing ROI and proactive management on their behalf.
The CMS regulations around home care offer a unique opportunity to help health plans reduce unnecessary utilization and lower costs while enhancing the quality of care patients receive. Data shows us that healing at home has positive impacts on readmission rates. This is especially true in situations where non-medical caregivers are trained to recognize and report potential issues with patient health. Furthermore, professional caregivers supported by innovative technology and platforms can capture patient data to ensure patient progress is on track, lowering overall costs for health plans.
Health plans should seek out partners who can offer data-based insights and real-time monitoring platforms for patients in the home. With this approach, health plans will see improved costs tied to reduced readmissions, and, best of all, healthier, happier members.
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