Rural Markets May Offer Huge Upside for Home Care Providers Looking to Break into Medicare Advantage

Many home care providers jumped at the chance to create new Medicare Advantage (MA) business lines after the U.S. Centers for Medicare & Medicaid Services (CMS) began making supplemental benefits more flexible more than two years ago.

Now, those same providers that got into MA early are beginning to better understand the space while hunting for different ways to boost their bottom lines. Some, for example, see robust opportunity in home care’s rural markets, specifically. 

That’s one area that Denver-based Homewatch CareGivers (HWCG) is looking to make its mark in 2020 and beyond. With more than 200 U.S. locations, HWCG is one of the biggest franchise companies in all of home care.

To discuss HWCG’s MA strategy, Home Health Care News recently connected with VP of Strategy and Health Care Innovation Jennifer Ramona. Ramona joined HWCG in 2013 and was promoted to her current position in August of 2018. 

HHCN: You took over as the VP of strategy and health care innovation in August 2018. What were your early goals in regard to MA — and how have those goals changed? 

Ramona: Having identified the plans offering benefits where personal care is incorporated in 2019, we have taken a two-pronged approach. We have doubled down on our MA efforts, including investing in additional supporting roles and infrastructure to support our offices with pursuing MA business. 

We started engaging locally with MA plans early so we could, in turn, show the value of those partnerships to both beneficiaries and our franchisees. We’ve also worked to educate our network about how it all works, how franchisees can be positioned to help all of their clients that have Medicare Advantage policies, and how they can engage with local plans and pursue those opportunities.

Our strategy has mostly changed to recognize and accommodate the needs around COVID-19. We were already in the process of implementing a new practice-management system to better accommodate high-volume authorization and claims-based business, but now we also have to make sure that the system can help us screen clients and staff for exposure and symptoms — and can support virtual care when appropriate. This is valuable to plans that need a provider to take 17 to 30 clients at once, manage care and costs within the benefit for the sake of the plan and the clients, and demonstrate that we are mitigating risks while providing innovative ways to keep clients engaged. 

We understand this will be an evolution as we try to objectively demonstrate the return on investment of in-home support services, specifically on outcomes and costs — and particularly for those patients with chronic conditions. 

HWCG CEO Jennifer Tucker said in March that MA had not been a huge windfall for HWCG yet, but that you didn’t expect it to be. When are you expecting to gain more momentum?

We are now pleased to see momentum in a few markets based on where MA plans are being offered and where the value of home care services is being recognized. We’ve experienced further momentum throughout COVID-19, where at least one plan sees the value of our services to their population in lieu of facility-based care or to support remote care. The need for virtual care — and support for it — has accelerated as a result of COVID-19. We are aligned with industry and government officials who believe remote care services are more than a trend and are here to stay.

How do you communicate the right strategy for developing plan partnerships to your franchisees?

We have a resource page on our intranet to help our franchise owners understand how to talk about Medicare Advantage with plans. The collection of resources includes information on how to identify plans in a market that’s offering in-home support benefits and how to approach them, among other helpful details. 

In addition to having those resources, we communicate information through webinars, newsletters and one-on-one consultations.

Is there an aspect of MA communication with franchisees that’s most important?

Getting past the first hurdle: being able to clearly identify to the plan and beneficiaries what the benefit you are providing is and why or how it’s vital. 

Clarifying benefits or services that are similar can also be challenging. This is why, as part of our resources and strategy, we provide a glossary of terms and vernacular to approach plans. 

What markets do you think are ripe for MA in the future? What makes them that way?

We see major opportunities for MA in rural markets, as well as markets with a high density of facility-based care residents who are seeking alternative solutions.

Over the past several months, the need for virtual care has accelerated. Home care services have been proven to be even more essential as consumers seek alternatives to nursing homes and assisted living facilities, and as health care providers and payers are pursuing home-based options for their patients.