The Case For and Against Home Care Provider-Medicare Advantage Relationships - Home Health Care News

The Case For and Against Home Care Provider-Medicare Advantage Relationships – Home Health Care News


Shifting health care paying trends have home-based care providers stuck between two battling business decisions: “adapt or die,” or sustainability.

Those two decisions may look like one in the same to outsiders, but for home care operators grappling with whether to engage with Medicare Advantage (MA), they sometimes posit providers on different sides of the aisle.

The tense relationship between the home health care industry and MA has been covered extensively on Home Health Care News. Providers are trying to fight back – as MA grows its market share among Medicare beneficiaries – against what they feel are unfair reimbursement rates from plans for home health services.

Conversely, we’ve often written about MA involvement as an opportunity in non-medical home care for providers in that industry. To some extent, it still is. Primarily health-related benefits and Special Supplemental Benefits for the Chronically Ill (SSBCI) offer a new revenue stream and client base for providers.

But not all home care agencies view MA as just another opportunity or revenue stream. After all, they deal with similar issues to the home health care world when it comes to working with MA: rates are meager and, additionally, the resources it takes to staff those cases is sometimes not worth the yield.

On the other hand, some providers think that engaging with MA now will be worth the return on investment down the line.

In this week’s exclusive, members-only HHCN+ Update, I try to paint the whole picture on the MA conundrum through the perspective of home care leaders.

Sign up for HHCN + to read this exclusive content.

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