With Medicare Advantage now dominating traditional Medicare, home care agencies need to build up stronger relationships with MA plans, healthcare leaders stressed at a webinar sponsored by the National Association for Home Care & Hospice this week.
Leaders from four different healthcare organizations spoke about growing MA enrollment and its importance to home care. Medicare eligibles are growing by 6% annually. Over 50% of states have at least 50% to 60% enrollment in MA, said VNS Health Vice President of Financial Planning and Analysis Glenn Tolchin.
“The number of MA plans has doubled in the past 10 years to 4,000,” he said.
The webinar occurred on the heels of a report from the Kaiser Family Foundation that said that MA now provides coverage for just over half of eligible beneficiaries. In January 2023, 30.19 million of the 59.82 million people with both Medicare Part A and Part B were enrolled in a private plan.
Understanding these plans and working with them is important to the home care industry, according to Liberty Healthcare Vice President of Business Development David Holmes. He gave tips on negotiating with regional MA plan providers. Plans must meet time and distance requirements for home health agencies, he noted.
“If you’re the only home health agency within a certain market, you need to leverage that opportunity with that smaller plan,” he said.
Holmes said that most companies want MA contracts to be negotiated by June each year and suggested that contract conversations start earlier in the year. He also shared important questions home health agencies should be asking regional MA plan providers. These include: What are the plans’ targeted membership goals? What is their geographic coverage area? Who are the plans’ partners?
It’s important to know the plans’ strategies to better negotiate with them, he offered.
“Are they partnering with particular pharmacies to get a particular patient group into their plan?” he asked. “Ultimately, are they making strategic alliances with physician groups in order to move patients from one health plan to another?”
