It’s that time of year again, when healthcare industry experts pause for a moment to reflect on the past year and share industry predictions on what may be around the corner. As the landscape of home care services becomes increasingly complex, it can be difficult to hazard a guess at what’s going to happen tomorrow, let alone next year. However, amid the uncertainties that lie ahead, it’s safe to say that home care services — already invaluable to many — will assume even greater importance. In anticipation of heightened demand fueled by an aging population, 2024 will likely bring concentrated efforts to stretch resources and identify solutions to home care industry challenges. Here are a few trends and predictions to keep an eye on in the new year:
States will look to address challenges related to LTSS
Many states are focused on the common goal of prioritizing long-term services and supports (LTSS), which means identifying and implementing sustainable solutions to problems that pose a threat to the health of LTSS programs. KFF’s 21st survey of state officials administering Medicaid home and community-based care (HCBS) programs in all 50 states confirmed what most industry insiders already are aware of. More than half of responding states cited a key priority or challenge related to LTSS.
Several are apprehensive about maintaining HCBS expansions powered by pandemic-related flexibilities and enhanced funding made available in the 2021 American Rescue Plan Act (ARPA). Other state concerns include payment rate reporting difficulties, shortages of HCBS workers, compliance with the HCBS Settings Rule, implementation of Electronic Visit Verification (EVV) systems, enhancement of HCBS compliance and quality, the aging of the population, and nursing facility and HCBS provider financial challenges.
Medicaid redetermination efforts will have lasting impact
Due to the continued fallout from redetermination, long-lasting implications are likely. According to projections, over 10% of the population will be uninsured by 2033, which is especially detrimental to Medicaid beneficiaries receiving long-term HCBS through Medicaid waivers; they are the most vulnerable program members.
Because 71% of people lost coverage for procedural reasons, it’s probable that a significant portion are actually still eligible. Obviously, more visibility is needed on the impact of this population during the unwinding period. The process in general likely would benefit from more centralized oversight and consistency across the board. Well into the process, it has become apparent that different states are reporting different experiences. For example, Virginia automated 66% of renewals and rejected 7% for procedural concerns. In contrast, three states — New Mexico, Utah and Nevada—– reported over 90% of their disenrollments were for paperwork reasons.
Self-direction will continue gaining traction
Self-direction is a model of long-term care delivery that lets an individual choose when, how and from whom they will seek services. The idea that clients understand their needs best and can manage their care has gained ground as benefits of the approach come to light, such as improved health outcomes, fostering independence, fewer gaps in care and reduced workload for caregivers, among others.
While all states must provide members with options to create a plan for managing personal services, budget and workers, some go above and beyond to make self-direction as accessible as possible. Participants utilizing self-directed care have varied levels of control over recruitment, hiring and training of staff, as well as how their Medicaid funds in their personal budgets are spent depending on the state and program they are in. Kentucky, Louisiana and New Jersey are examples where prioritizing full authority to consumers self-directing has produced promising returns on their investment in self-determination.
Kentucky supports its 12,000+ self-directing residents by giving them full employee and budget authority. The program benefits from nine funding sources and serves an impressive five populations. Louisiana’s approximately 2,000 self-directing residents stem from two populations through the Office of Aging and Adult Services (OAAS) and the Office for Citizens with Developmental Disabilities (OCDD). OCDD’s self-directing members have employer authority and are shifting to budget authority as well. OAAS members have budget authority. The program benefits from six funding sources.
New Jersey’s 28,867 self-directing residents are Medicaid and FamilyCare members with an assessed need for personal assistance, which is a broad requirement that makes care more accessible. The program is funded by three sources and it permits budget authority.
Targeted training programs will enhance VBC, minimize gaps in care
Value-based care (VBC) is gaining popularity for its usefulness in closing gaps in care. Subsequently, it’s driving a need for specific training, which better enables caregivers to identify issues that must be noted for VBC to work. When properly trained, caregivers are more likely to spot changes in condition or social determinants of health and can alert providers or, if needed, initiate the connection of members to social services programs.
For example, a worker may pick up on environmental problems, such as limited access to food, or unsafe conditions, like a home wheelchair ramp in need of immediate repair, which can be reported to ensure it’s fixed to prevent injury. This gives healthcare providers a head start on addressing factors that may adversely affect an individual’s condition or lead to future medical emergencies.
Having a structured path and the right resources for reporting such information and collected data is key. To propel those VBC efforts, the industry must utilize training programs and Electronic Visit Verification platforms as convenient and effective tools. EVV takes it a step further. In addition to benefiting workers, it also lets payers streamline home care claims management. Because claims cannot be submitted unless the service rendered reconciles with both the authorization and the electronic verification of the visit, denials are heavily reduced.
In addition, providing better training to caregivers and allowing them to become more specialized maximizes efficiency that contributes to staff retention. It streamlines caregivers’ jobs, lightens their workloads, empowers them to take more of a leadership role, and provides the support they need to administer the best possible care. Furthermore, many caregivers have reported they’re more likely to remain with an employer who offers resources to help them further their education and prioritize the care team’s overall well-being and happiness.
These tactics also cut down on fraud, waste and abuse within the home care industry. HCBS providers who earn credentials through training and performance validation are positioned to support goals associated with value-based care. Theoretically, when workers understand the process better, their efficiency with management software and EVV systems would increase, resulting in more complete sets of visit data that can be carefully analyzed.
More home care agencies will consider payer, service diversification
The momentum behind payer diversification is increasing as the aging population expands. Traditionally, home care payment options have primarily revolved around Medicaid, though some agencies that provide nonskilled personal care may also offer clinical services and skilled healthcare, covered by Medicare. However, the number of Americans ages 65 and older is in the process of doubling, and the subsequent demand for care likely will prompt many members to seek new and alternative methods of payment.
Some may possess VA benefits or long-term care insurance, while others opt for self-payment, utilizing various forms such as FSA or HSA accounts, credit cards or cash. Agencies that can accommodate these diverse payment choices are more likely to attract new clients and experience substantial growth. Offering a diversified mix of payer options allows customers to select the provider they like best rather than having to choose one based on whether their preferred method of payment is accepted.
Though the home care industry is working its way through some challenges amid tumultuous times, there is good news. Provider organizations, payers and caregivers can take steps now to ensure they are prepared for industry changes and updates the new year may bring, which helps to improve member outcomes and increase caregiver retention. Agencies that explore the available resources, solutions and tools now are strategically positioning themselves and their clients for success no matter what 2024 has in store.