Seema Verma, former CMS Director

It’s nothing but up for the Medicare Advantage program, Seema Verma, former administrator of the Centers for Medicare & Medicaid Services, predicted Tuesday.

“I think MA is going to go gangbusters,” she said in a question-and-answer format at the Home Care 100 Leadership Conference in Scottsdale, AZ. Bill Miller, CEO of technology firm WellSky, on which Verma is a board member, moderated the session.

Bolstering her view is CMS’ proposed 7.98% payment increase to MA plans in 2023. She noted that the private form of Medicare soon will encompass 50% of the Medicare population “in short order.”

The supplemental benefits available through MA plans, such as home care, transportation and meals, offer “unprecedented” opportunities for home care providers, she added.

Bullish on value-based care

Verma was not shy about expressing enthusiasm for value-based care in general. While she gave the Build Back Better legislation slim chances for passing, she said she is confident the expansion of home- and community-based services will happen in the context of value-based care.

Federal and state lawmakers are reluctant to increase such services because of cost. One of the advantages of value-based care is insurance companies are in charge so they can be more creative, flexible and experimental with offerings.

It also has bipartisan support, she pointed out.

“By 2026, we’ll run out of money,” she noted of traditional Medicare fee-for-service. “The path forward is value-based care.”

Data is key

Data is critical in this value-based world, she said.

“I don’t think you can have value-based care without having great data behind you,” she said.

Providers need to have data, and it needs to follow people through their transitions of care.

“We have the opportunity now to gather all this data and do the predictions,” she said, adding that providers have to invest in technology to do that.

Data will also come in handy in helping home care providers be in a stronger bargaining position with MA plans, she said. During the question-and-answer session, a participant commented on the low rates MA plans are paying home care companies.

“When data comes out, you’ll have another tool in your toolbox, so to speak, in terms of negotiating,” she said.

When asked to characterize the current era, she said it is the time of home-based care.

“This is the shift to the home, this is the turning point,” she said.

COVID-19 helped to accelerate this shift, she pointed out. At the same time, technology, including remote monitoring and telehealth, has enabled the delivery of more care into the home.