SCOTTSDALE, Arizona (February 8, 2022)—Medicare Advantage programs are likely to continue to grow at a rapid pace, replacing traditional Medicare coverage for America’s seniors in increasing numbers, former Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said Tuesday.
“I think Medicare Advantage is going to continue to grow gangbusters,” Verma told attendees at the Home Care 100 conference, which gathers CEOs and other leaders in home health, hospice and personal care. “It will be at 50% in short order.”
That’s not necessarily good news for home health providers. The looming domination of Medicare Advantage (MA) and other managed plans—and the difficulty of negotiating with them—was a recurring theme at the conference. About 42% of Medicare beneficiaries were enrolled in MA plans in 2021, according to the Kaiser Family Foundation.
“As MA continues to grow, even if you put all of us together at this table, we don’t have enough market share to begin to where we have some symmetry of power,” said Bruce Greenstein, chief strategy and innovation officer at LHC Group; he shared the dais with leadership from BAYADA Home Health Care, Kindred at Home and Amedisys Home Health Care & Hospice—some of the larger homecare companies in the country.
“It’s time for a serious wakeup call; we need to stop sugar coating what’s happening right now,” Greenstein continued.
Bill Dombi, president of the National Association for Homecare and Hospice, said that the industry will be looking closely at Medicare’s and Medicare Advantage’s encounter data and advocates are prepared to either push MA plans or fight them depending on outcomes.
“If we have to work with them for success, we’ll work with them for success; if we have to challenge them for success, we’ll challenge them for success,” Dombi said on a panel.
Verma encouraged providers to use their own patient data to prove value and gain a strong platform for negotiating with MA and other payers. She also said they could look at providing some of the supplemental benefits that go with managed care plans.
She also said the same data—as well as the rise of predictive analytics—can lead to reduced costs and better outcomes in all aspects of health care, especially home- and community-based services. And she praised in-home care for allowing providers to see and address the social determinants of health that aren’t apparent with a primary office visit.
She expressed skepticism that the Biden Administration’s Build Back Better legislation—which originally included $400 billion for homecare and has been scaled back—will pass this year.
“I wouldn’t put on any money on it, let me put it that way,” she said.
“That being said, I think for the industry I wouldn’t be giving up hope in terms of the expansion of services,” Verma continued. “Where I think services will be expanded … is in the context of value-based care.”
And she said the country is in the midst of a transition to providing more—and more acute—in-home care and also investing more in homecare and in innovations driving the industry forward.
“I think this is the shift to the home. This is the turning point,” Verma said. “It was kind of going on before but COVID really accelerated that. At the same time, there’s a lot of new technology out there that’s enabling that, such as telehealth and remote patient monitoring, and there’s an understanding and appreciation and a potential for going out in the home.”
