We Need To Go Where The Patients Are’: How Home Health Agencies Are Adjusting To Medicare Advantage

Home Health Care News | By Patrick Filbin

Medicare Advantage (MA) enrollment has been on a steady climb over the last two decades. As such, home health agencies have started to adjust operations to better fit the payer landscape in the future, and not just now.

Agencies in states like Michigan, Hawaii and Alabama have already had to do that — and those transitions haven’t been seamless.

Cleamon Moorer Jr., the president and CEO of the Detroit-based American Advantage Home Care, has been molding his company’s strategy around one of the greatest NBA point guards of all time.

“We’re understanding that we need to take a lead position and meet patients where they’re going,” Moorer told Home Health Care News. “It’s like the ‘80s Lakers with Magic Johnson. He threw the ball where Worthy was going to be, not where he was at. We need to go where the patients are going to be.”

American Advantage Home Care provides skilled nursing, rehab and specialty care services. Currently, the company serves seven counties in the Southeast Michigan area and has a census of 200 patients.

Changing of the tides

In 2023, 30.8 million people were listed as enrollees in a Medicare Advantage plan — which made up 51% of the eligible Medicare population — and $454 billion (or 54%) of total federal Medicare spending, according to KFF.

The share of Medicare beneficiaries enrolled in Medicare Advantage varies widely across states and counties, however.
Providers are concerned about MA plans’ reimbursement rates for home health services. Meanwhile, patients have some reason to be concerned over the home health access they’ll have underneath an MA plan.

“One concern that certainly comes up is that one in 10 Medicare Advantage patients say they have trouble accessing needed care,” Jennifer Schiller, executive director at the Research Institute for Home Care (RIHC), told HHCN. “It’s a coverage [issue] — but I think everybody is constantly aware of the fact that Medicare Advantage is not going anywhere.”
The tides have already started to shift in favor of MA.
Enrollment in MA has seen gradual increases (8% in both 2021 and 2022) and there is no sign of it slowing down.

“I think you’re going to see some more changes — especially over the next few years with various regulations that may impact who is using home health and who is using Medicare Advantage,” Schiller said.

In order to capitalize on that shift – or survive it – home health providers have had to adjust.

Challenges in MA…

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