Insights on the Homefront

Expanded MA supplemental benefits are largely tied to CMS’s updated guidance allowing plans to cover anything that has “a reasonable expectation” of improving or maintaining the well-being of beneficiaries with chronic conditions.

MA plans are an alternative to traditional Medicare, encompassing inpatient, outpatient, and prescription drug benefits. In 2018, CMS announced that MA plans would expand to cover home-based services as well. The new plans include several new services that are available to millions of MA plan members. Since their introduction in 2010, MA plans have become increasingly popular among Medicare recipients, and the additions planned for 2020 will likely add to this enthusiasm.

When case managers partner with a structured community-based palliative care (CBPC) solution, they gain a set of “eyes and ears” into the homes of members struggling with a serious illness, resulting in better care coordination and better outcomes for members and their families.

As the healthcare climate pivots from fee-for-service to value-based payment models, Medicare Advantage benefits are expanding to include a broader scope of offerings. Insurers are slowly realizing that the value of offering these benefits is far greater than paying for treatment costs, including time spent in high-cost, acute care facilities, once a patient’s illness becomes more severe.

On November 21, 2019, California’s major power utility, Pacific Gas and Electric (PG&E) announced that its latest round of systematized power outages had concluded and they would begin restoring power to the (more than 40,000) Northern California residents who had been without power for the duration of the week. For thousands of Californians, the outages were more than just a mere inconvenience, and for many, being unable to access electricity is a matter of life and death.

In January 2019, the Centers for Medicare and Medicaid Services (CMS) announced an expansion of its “value-based insurance design” (VBID) model for Medicare Advantage (MA) plans. With the industry moving away from fee-for-service models and towards fee-for-value arrangements, the Medicare Payment Advisory Commission (MedPAC) has advocated for the addition of carved-in hospice benefits to Medicare Advantage plans, including a test of this offering, starting in 2021.

Within the home health space, many of the current open home health employment opportunities involve very labor-intensive work for little pay, which trend analysts forecast could result in detrimental staffing shortages.