One the largest non-profit Medicare Advantage (MA) health insurance companies in the nation is open to working with senior living providers as new benefits are rolled out in 2019.
Senior housing operators across the country are evaluating Medicare Advantage opportunities in light of a change announced last April. That’s when the Centers for Medicare & Medicaid Services (CMS) stated that MA insurers would be allowed to cover non-skilled in-home care starting in 2019. Considering that assisted living providers often perform this type of care, such as helping residents with bathing and dressing, the CMS change opened up the possibility that MA dollars could start flowing to senior housing and care companies.
Only a small percentage of MA plans are offering these new supplemental benefits next year, according to data from AARP and health care consulting firm Avalere. However, a few insurance companies are offering some new benefits, including Long Beach, California-based SCAN, which announced its “Returning to Home” and “Home Advantage” offerings in mid-November.
SCAN serves more than 195,000 members in California, making it one of the largest nonprofit MA plan providers in the nation. SCAN was able to quickly add new supplemental home care benefits because it has covered similar services in the past, Jill Selby, corporate vice president of product development, told Senior Housing News.
From 1985 to 2004, SCAN operated as a social health maintenance organization (S/HMO), which allowed the company to offer some non-skilled in-home care benefits. In addition, SCAN covers these types of services in some of its existing special needs plans.
“We had an advantage because my playbook was wire-framed out already,” Selby told SHN.
The Home Advantage offering is focused on fall prevention, and involves an occupational therapist visiting a beneficiary’s home to evaluate risks and offer recommendations, such as removing hazardous carpeting or moving dishes to lower shelves.
Returning to Home is focused on reducing hospital readmissions. After an MA beneficiary returns home from a hospital or skilled nursing facility stay of at least one night, the individual can receive up to 16 hours of personal care, up to 84 meal deliveries per year, and support and advice from a care navigator.
These benefits will be open to SCAN Medicare Advantage members who live in senior housing communities, Selby said.
To provide these benefits, SCAN already has contracts in place with home care agencies across markets that it serves. It’s possible that SCAN would contract directly with an independent living or assisted living company that has caregivers on staff and residents signed up for these new plan offerings, Selby said. Certain conditions must be met, though.
To contract with SCAN, a senior living facility would need to meet criteria such as having intact liability coverage and proper, sufficient caregiver credentialing. Some of these requirements are in place because SCAN is contracted with the federal government, Selby noted.
Business considerations such as operational efficiencies will also come into play.
“Oftentimes, there isn’t a great enough concentration of SCAN members in a facility, [and] what ends up happening is we have 1,000 contracts spread across all these facilities, and managing a contract that serves one member isn’t really efficient,” Selby said. “But I never say never. Hear me say that, but I also want to be realistic.”
Customer satisfaction is also important to Medicare Advantage plans, so this could help drive decision making.
“If someone said, ‘I really want you to use Joanie [as my caregiver], I’ve used her in the past, I’m comfortable with her,’ we would do everything in our best efforts to go ahead and create a contract,” Selby said.
While the new benefits are relatively limited in scope for 2019, they likely will become increasingly robust in the future for SCAN and other insurers.
”I think you’re going to see a lot of plans really plunging into that space to the extent that Medicare lets you,” Selby said. “I definitely think [benefits] will grow, especially for SCAN.”
A growing trend
SCAN’s comments largely echo those of Anthem (NYSE: ANTM), which is also introducing new supplemental home care benefits in 2019. Both companies are generally open to contracting with senior living providers or otherwise forging partnerships with them, although in these early stages there are few concrete efforts underway, and it’s unclear what the financial arrangements would look like.
“It’s an open question for me, how do we work with these facilities in the future?” Martin Esquivel, vice president of Medicare product management at Anthem, told SHN in October. “Going forward, we want to push the innovation buttons and see what we can do together.”
As insurance companies create their benefits packages and consider potential senior living plays, some senior living providers are taking the bull by the horns and starting their own MA plans.
Lynne Katzmann, CEO of Bloomfield, New Jersey-based Juniper Communities, is leading an effort to create a consortium of providers to start a plan. And some senior living providers — including Catonsville, Maryland-based Erickson Living and McLean, Virginia-based Sunrise Senior Living — had already launched their own MA offerings even prior to the April announcement from CMS.
Sunrise’s plan — dubbed Sunrise Advantage — is currently available in four states and is resulting in more meaningful integration with the overall health care system, CEO Chris Winkle said last week during an investor day presentation for real estate investment trust Welltower (NYSE: WELL).
Physician referrals to Sunrise are up 300% since Sunrise Advantage launched, he said.
Existing Medicare Advantage insurers likely will become more involved in senior living due to the new home care supplemental benefits, but a bigger game changer will probably be the MA plans that originate within the industry, according to Anne Tumlinson, CEO of consulting firm Anne Tumlinson Innovations.
Senior living providers that create their own plans can tap into the new supplemental benefits as well as more well-established options such as institutional special needs plans (I-SNPs), with the goal of creating bottom-line value for the senior living business while also enhancing residents’ outcomes and experience, Tumlinson told SHN last August.
Written by Tim Mullaney
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