Aetna Bucks Medicare Advantage Trend, Continues To Invest In Home-Based Care Benefits

Funding for fee-for-service home health care and home- and community-based services ebbs and flows. But the payer source most likely to dictate the future of home-based care providers – across the board – is Medicare Advantage (MA).

MA plans aren’t immune to tough rate environments, either. In fact, they’re in one right now. That’s one of the reasons why in-home supplemental benefit offerings will take a dip for the first time in 2024.

In-home support services (IHSS), which offer an MA entry point for home care providers, will take a major hit. IHSS grew rapidly from 2020-2023, with the amount of plans offering them growing from 283 to 1,308. In 2024, though, only 867 plans will be offering IHSS, according to the research and advisory firm ATI Advisory.

That has caught the eye of providers and health care analysts.

“Given the tougher MA reimbursement backdrop for 2024, plans are prioritizing certain supplemental benefits, driving a more dichotomous path related to year-over-year supplemental benefits penetration vs. 2023, which generally exhibited increased supplemental benefits penetration across the board,” Scott Fidel, managing director at the investment banking company Stephens, wrote in a note shared with Home Health Care News.

The reduction of supplemental benefit offerings – both of the Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI) variety – is discouraging, particularly for home care providers that have invested a lot in catering to MA business.

It’s my feeling that this is a blip, however, and that MA plans will continue to find ways to work with home-based care providers to reduce member hospitalizations in the future. To make sure of that, I chatted with Terri Swanson, the president of Medicare at CVS Health’s (NYSE: CVS) Aetna.

This week’s exclusive, members-only HHCN+ Update dives into where MA plans, including Aetna’s, are headed from a home-based care standpoint in the next year and beyond. I also share a couple of other recent MA developments that providers should know about.

Bucking a trend

The drop in IHSS offerings is not just because of higher regulatory scrutiny above MA plans’ heads, Bill Winfrey, the director of Medicare innovation at ATI Advisory, recently told HHCN.

“We suspect the main reason behind the decrease is that IHSS is a more administratively complex benefit to offer, especially compared to something like a grocery card,” Winfrey said. “To offer the benefit, plans must identify providers in a crowded marketplace, build a provider network to ensure market coverage and manage increasing labor costs that are driving up the cost of the benefit itself.”

The complexity behind offering such a benefit is why companies like The Helper Bees exist in the first place. The Helper Bees builds out a network of home care providers on behalf of the MA plans to make delivering on the promise of home care services easier.

The Centers for Medicare & Medicaid Services (CMS) also announced earlier this week that it would be paying closer attention to supplemental benefits, ensuring that members are both aware of the benefits and using them if needed. This is partly because, in CMS’ view, plans are largely using supplemental benefits as a marketing scheme rather than a service benefiting members’ health.

“Plans have reported that enrollee utilization of many of these benefits is low,” CMS wrote in fact sheet. “To ensure the large federal investment of taxpayer dollars in these benefits is actually making its way to beneficiaries and are not primarily used as a marketing ploy, the proposed rule requires Medicare Advantage plans to engage in minimum outreach efforts so that enrollees are aware of the supplemental benefits available to them.”

Higher utilization of the benefits would be good news for providers that have committed to taking on MA members as clients.

But, in theory, higher utilization should be good for plans as well. If the benefits are utilized correctly and address social determinants of health, through home care and other means, that would be of benefit to members’ overall health.

On Aetna’s end, it believes that a home-based care approach begets more home-based care usage. Through Signify Health – which is also a part of CVS Health – Aetna offers all MA members an annual “healthy home” visit.

Healthy home visits are a way for Aetna to screen patients and their homes for health concerns or other needs. It’s a type of care that has become more popular in MA over the past five years.

“They evaluate the home environment to see if that member has things in their environment that could be improved, or whether there are things that could lead to a fall risk,” Swanson told me. “We just think it’s a really wonderful service, … especially because four out of five people surveyed say they want to receive care in their homes.”

The healthy home visit from Aetna also allows the insurer to connect members to the supplemental benefits it does offer, including IHSS.

Aetna does offer IHSS across the country, but the benefit is still utilized on a smaller scale than the healthy home visit, Swanson said.

“[The IHSS] are gaining in popularity, particularly for people who have mobility issues or trouble with transportation,” she said.

There are different “flavors” to IHSS benefits under Aetna, Swanson explained.

The first is a benefit where there’s a set number of hours of personal care services – provided by a home care provider – that a member can use in whatever way they feel best. Those don’t need to be ordered by a doctor, either, and can be used at the discretion of the member.

Then, in some plans, there are hours of personal care set aside for members during the 30 days following a discharge from an inpatient facility. That’s much more geared for those undergoing a recovery process, which home care providers are used to handling.

Aetna sees considerable value in these home-based care services, and Swanson said that it is evaluating how the above benefits are utilized when considering “future expansion.”

“We want to be proactive; our goal is to get in front of a situation that would develop the need for hospitalization or some other kind of significant health event,” she said. “We want to get in front of that, and help the member enjoy their life. That is why we offer these types of services.”

Despite the rate environment, Aetna has been able to “maintain and even invest further in” supplemental benefits. Swanson credited that, plus the fact that 87% of Aetna’s MA members are under plans rated four stars or higher, as reasons to be bullish on enrollment moving forward.

Alongside Blue Cross Blue Shield, Humana and UnitedHealthcare, Aetna is one of the largest MA insurers in the country. Its commitment to home-based care is necessary context in the overall story that is being told, which is that home-based care benefits are down.

They may be down, but the actual amount of opportunity shouldn’t fall too much for home-based care providers. The plans that have committed to actually offering those benefits to members, like Aetna, are not pulling out.

In case you missed it

There have been several interesting Medicare Advantage developments over the past few weeks. While not all related to home-based care, they’re interesting nonetheless.

These developments include:

– On Thursday, progressive members of Congress hosted a press conference “on the shortcomings of Medicare Advantage.” The conference, which shows continued scrutiny of MA, was held at the halfway point of Medicare open enrollment.

– On Monday, CMS announced it was also taking steps to improve access to behavioral health care services for MA plan enrollees by proposing updates to network adequacy standards.

– A report from Reuters suggested that Cigna could sell its Medicare Advantage business for “several billion dollars.”
– A study released at the start of November found that Medicare Advantage has 70% fewer readmissions than fee-for-service Medicare, with 24% fewer preventable hospitalizations.