There’s no question that many aspects of healthcare are moving out of the hospitals, but health plan executives are still grappling with what that means for care services and delivery.
More and more often, payers are looking for ways to encourage patients to use outpatient services, such as primary care settings. They have also begun reimbursing for virtual services, like telehealth. The shift that moves care from the acute and institution-based settings to the community naturally leaves payers sizing up how to engage patients where they spend the most time: their homes.
The rise of consumerism in healthcare as well as the federal government’s ongoing expansion of value-based care policies offer payers another tool to bend the cost curve – expanded supplemental benefits, including non-medical home care. Payers are likely to partner with strong, tech-based partners who have experience providing these services, and at scale. Therefore, when sizing up an organization, payers must ask these questions to see if non-medical home care is right for them:
Should our organization offer non-medical benefits?
In April, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that allows payers to expand supplemental benefit offerings in Medicare Advantage plans for 2019. These new features can include non-medical benefits like transportation and meal delivery.
The Medicare Advantage market is growing, increasing the federal government’s share of healthcare purchasing power. The government’s percentage of Medicare Advantage premiums, for example, rose to 25% in 2017 compared with 17% in 2007.
The “silver tsunami” — the event of the large-in-numbers baby boomer generation entering into retirement — is in full swing. As an affluent generation, boomers are accustomed to making their own decisions that fit their lifestyles. That includes their healthcare services. MA plans enrolled 21 million members in 2017 — about a third of Medicare customers. That number is expected to climb to 50% of the Medicare market share by the end of 2025 as baby boomers age.
Offering supplemental, concierge-like features helps attract these boomers to Medicare Advantage plans. That’s why payers like Oscar are entering the market while incumbents like Anthem are trying to hold and build their MA customer base by partnering with other healthcare-interested companies like Walmart. Centene recently partnered with the hospital system Ascension to create a Medicare Advantage plan. These plans are offering convenience for healthcare services such as increased access to over-the-counter medication or rides to doctor appointments.
While Medicare Advantage is only one type of insurance plan — and benefits vary from plan to plan — the insurance industry’s interest in the market and the government’s willingness to increasingly cover supplemental benefits for improved quality and decreased total cost of care is a tell for where the industry is heading.
What does the literature say regarding non-medical benefits’ impact on readmissions, reduced unnecessary utilization, and reduced cost?
While the insurance industry is clearly moving toward more in-home and outpatient care settings as preferred environments, it’s still very much the wild west with regards to how these efforts will affect care.
Take rideshare services for non-emergency medical transportation (NEMT) as an example. Providing transportation seems like an easy win for healthcare providers as nearly 3.6 million U.S. patients miss at least one medical appointment due to a lack of transportation. Companies such as Circulation, Lyft, Uber, and Kaizen have all recently entered the market to provide their services to those in need of a ride.
Continued research needs to be done on the benefit on transportation services through ridesharing companies, but recent studies have shown promise. For example, a Lyft/Hitch Health study experienced a 27% reduction in patient no-shows during a 12-month time period as a result of a ridesharing pilot program with Hennepin Healthcare in Minneapolis.
Payers need to be mindful that these value-based initiatives — despite the longstanding rhetoric — are still new to the field.
What patient populations will benefit most from such benefits?
While demonstrating the path to improved outcomes, payers must know for whom supplemental benefit programs are being developed.
Not all populations are created or managed equally. Reality is different for someone if they live in Los Angeles as compared to someone living in Louisville. Although both are U.S. cities, they have important differences in density, wealth, climate, crime, access to food, and education.
Healthcare is local. Payers need an intimate understanding of their patient population to achieve their intended benefits. As chefs may not begin to cook the same meal for 20 people for fear of dietary restrictions, so must payers know what they are getting into in terms of benefit planning. Further, plans need to build relationships with trusted partners who have the appropriate processes and experience in successfully administering these benefits to their patient population.
How can we best provide services in the lowest cost care setting — the home?
There is no question payers will need to evaluate how to best incorporate non-medical support in the home. Luckily for them, their previous efforts have laid the foundation for meeting patients where they are most comfortable to provider care — their home.
The rise of consumerism, patients desiring a more personalized experience, technology being able to remotely connect people, and a continued desire to bend the cost curve while improving quality of care ultimately leads to more services being delivered in the home.
After all, spending time in a patient’s home gives more context into his or her life than a 10-minute hospital visit ever could. The industry trends of moving care upstream offer ample opportunities for non-medical home care workers to act as partners with payers and health systems.
Home care workers can provide information, details and context on a proactive day-to-day basis rather than waiting for a patient to show up in the ER. This constant engagement creates trust with in-home workers and the patients, who may be more willing to take the medical advice provided by medical staff through the mouths of their known companion and support, the in-home caregiver.
Seizing the Opportunity of Non-Medical Home Care
Healthcare reform is still very much a work in progress. Health plans need to keep their eyes on the home-care-prize and not settle for non-medical home care partners who don’t prioritize patient needs by gathering actionable patient data. It’s only with the right goals and a measurable process in mind that payers can seize the opportunity to not only bend the cost curve but also create healthier, happier members.