Making Medicare Advantage Work for Homecare

Medicare Advantage (MA), the private health plan alternative to traditional government-sponsored Medicare, continues to grow nationwide. More and more older adults are choosing the MA plans, in part because of the exceptional benefits offered by managed care organizations. The average Medicare beneficiary could choose from more than 43 different MA plans in 2023, more than double what was available just five years earlier.

Today, more than 28 million Medicare beneficiaries, or 48% of all eligible individuals, are enrolled in an MA health plan. Many believe this number will surpass 50% in the next few years, if not sooner.

An Overview of MA Supplemental Benefits

In addition to the overall growth of MA plans, those same plans continue to expand to offer more and more benefits each year. Those benefits can include over-the-counter medicines, dental allowances and more. In 2023, more than 97% of all MA plans offered some type of additional benefit, very often with no extra cost to the MA member, including nonemergency medical transportation (NEMT) and remote patient monitoring (RPM).

NEMT and RPM, known as “nonmedical benefits,” are especially valued by MA members and homecare organizations. These nonmedical benefits are so prized by MA beneficiaries that 60% said they would choose a plan based simply on the number of free services offered, including nonemergency transportation.

NEMT and RPM are offered by 97% and 3% of individual plans, respectively, while vision benefits, for example, are offered by 99% of these plans. NEMT, a service where independent businesses take individuals to and from health care appointments, and RPM, in-home devices designed to monitor vitals and falls, are extremely important to those living independently in their own homes.

Both of these home-based care services are part of a larger trend of moving health care from a facility-based experience to a care-at-home model. McKinsey estimates that $265 billion of care services, or approximately 25% of the total cost of care for traditional Medicare and MA, will relocate to the home in the next two years.

“Care at home could improve the quality of care and the patient experience by providing patients with care in the comfort of their homes and by potentially reducing preventable adverse health events,” the McKinsey report said. “Additionally, stakeholders—including payers, health care facilities, physician groups, care-at-home providers, technology companies and investors—could see substantial value.”

Even so, the MA market continues to evolve as health plans evaluate how they spend supplemental benefit dollars. Their goal is to ensure benefits are cost-effective and lower the cost of care. So while the trend today is allowing MA members to spend on what they find valuable—like dental services and over-the-counter medications—that could change in the future.

The Importance of Homecare Services in the MA System

Homecare organizations and staff are positioned to understand an individual’s needs as they relate to NEMT and RPM services. Routine contact between the individual and the caregiver is a unique relationship that often makes homecare providers the first to know about changes in health status. Collecting data from within the MA member’s home may be the most advantageous way to understand the challenges of everyday life. An in-home caregiver, for example, will have firsthand information and data that can help health plans understand what prevents their members from getting health care services.

The member may:

• have behavioral health issues
• face transportation challenges
• struggle with food insecurity
• need help navigating the health care system

As a health plan’s eyes and ears, in-home caregivers are in a unique position not only to collect member data but also to act on it in a way that improves the member experience. Aligning activities of daily living with improving health and driving outcomes can help empower care aides and improve retention. As a care aide becomes more involved in a client’s everyday life, they can identify issues more quickly, gather acute and chronic health data and assist the homecare agency in organizing it in such a way that health plans can act. This, in turn, drives more value for the health plans and can help secure the homecare agency as a provider of choice.

RPM, NEMT & Aging in Place

Today, many people want to age in place by remaining in their own homes: in fact, 88% of older adults say it’s important to them. “While most older adults feel it is very important for them to stay in their home as long as possible, many are not prepared to age in place,” said the Institute for Healthcare Policy and Aging at the University of Michigan, National Poll on Healthy Aging.

But homecare services combined with NEMT and RPM can help these individuals prepare for and realize their goal of aging in place, especially for those older adults who can take advantage of these “nonmedical” services through an MA health plan.

Studies support the concept that RPM helps keep individuals healthy, improves outcomes and reduces overall health care costs. Mayo Clinic researchers publishing in the journal Nature found that of the more than 7,000 participants monitored, 79% used the device regularly. In addition, the researchers noted, “emergency department visit and hospitalization within 30 days of enrollment were 11.4% and 9.4%, respectively, and the 30-day mortality rate was 0.4%.” This research concluded that RPM use was “feasible, safe and associated with a low mortality rate” and supported further expansion of RPM programs.

“Home monitoring and hospital-at-home models offer the potential to transform care and potentially allow a substantial proportion of hospitalized patients to
receive care from home,” said a JAMA Viewpoint essay.

NEMT receives similar accolades from its regular users. This service helps individuals with chronic conditions, such as diabetes or congestive heart failure, get to and from health care appointments safely. Not having access to reliable transportation keeps approximately 5.8 million people from getting medical care every year and a lack of transportation is classified as a social determinant of health.

The paucity of transportation options also has a significant financial cost. Missed health care appointments—often caused by an individual’s need for a ride—cost $150 billion in the U.S. As an MA plan-provided service, NEMT helps individuals age in place and improve or maintain health while improving health equity among underserved populations and lowering health care costs.

When NEMT and RPM have a place in
the homecare setting, it’s much easier to help older adults age in place as these services help improve health, address health related social needs and lower health care costs