New data relating to Medicare Advantage (MA) benefits is on its way out for the new year. And finally, it looks as if optimistic home-based care providers that view MA as a potential revenue stream in the near- and long-term future are seeing their bullishness validated.
Just 267 MA plans offered Special Supplemental Benefits for the Chronically Ill (SSBCI) in 2020, but 1,292 will in 2022, according to new reporting from the Washington, D.C.-based research and advisory firm ATI Advisory. Compared to last year, 369 more plans will be offering these benefits in 2022.
It’s not just the amount of plans that are offering these benefits to their members, either. The amount of each benefit that they’re offering is also, on average, greater than what it was two years ago.
The increased number of plans with such offerings, plus increased leniency from them on each benefit, creates more opportunity for home-based care providers to step in.
“There’s a lot of good news here for home care providers,” Tyler Cromer, a principal for ATI Advisory, told Home Health Care News.
In addition to strictly SSBCI, which are not a part of primarily health-related benefits that MA plans offer, almost 1,000 plans are offering in-home supports services (IHSS) now. IHSS is unique in that it can be offered through either pathway actually – the primarily health-related avenue or SSBCI.
“That’s really significant growth from when this was first available as a benefit,” Cromer said.
As for the most popular SSBCIs in 2022, those include: food and produce, with 763 total plans offering; meals beyond a “limited basis,” with 403 plans offering; transportation for non-medical needs, with 375 plans offering; and “general supports for living,” with 328 plans offering.
Just beyond those are pest control and the ‘social needs benefit.’
“I think we expected to see growth in the number of plans offering SSBCI, and the data has confirmed that,” Elexa Rallos, an analyst at ATI, told HHCN. “We were expecting to see big growth in the benefits that a lot of members are asking about – things like food and produce and meals. But we’re also seeing a lot of growth in newer, more non-medical benefits – things like transportation and this general supports for living benefit, which is really interesting.”
SSBCIs can be offered to MA enrollees with one of more complex chronic conditions. The benefits are meant to curtail hospitalizations and other adverse health outcomes that these members may be more vulnerable to.
While food and produce, meals and transportation for non-medical needs are more straightforward benefits, general supports for living – as its name suggests – is less so.
Broadly, general supports for living have more to do with housing needs. The benefit is available to members so long as assistance with housing has a reasonable chance of improving or maintaining their health.
The benefit may include plan-sponsored housing consultations or subsidies for rent, according to the Centers for Medicare & Medicaid Services (CMS), which could help seniors live in their preferred homes longer. The benefit can also include subsidies for utilities such as gas, electricity and water.
In a similar vein is the social needs benefit, which is offered by 244 plans. Though some aspects of the benefit are outside of a home care provider’s reach – such as club memberships, family counseling and park passes – others like caregiving, support for isolation and cognitive function are not.
The majority of the benefits start, take place or end in the home. About one in every four MA plans is offering SSBCI at this point, according to Cromer.
“Just three years in, I think that’s a really big takeaway,” she said. “When talking to plans, we’ve heard a lot about the challenges and reluctance around adding these benefits because it’s a new area. There’s constraints, there’s funding [issues], and then there’s getting the attention of executives of health plans. But we’re hearing less and less about that. And we’re seeing that this is becoming an important part of what MA plans can offer their members. It’s all pretty exciting.”
The growth is coming from two different ends of the MA plan spectrum.
On one end, the large insurers like Humana (NYSE: HUM), Anthem (NYSE: ANTM) and Centene (NYSE: CNC) are really beginning to tick up their use of these benefits.
“We’re definitely seeing the big insurers drive very drastic growth, really since last year, and go pretty heavy on some of these benefits,” Rallos said.
On the other end, smaller plans are beginning to explore the benefits more frequently. In some cases, insiders believe offering SSBCI could be a way for these plans to stand out among a crowded field mostly dominated by the larger insurers.
“We are also seeing newer, smaller regional plans offer these benefits,” Rallos said. “So it is becoming more ubiquitous across the field, and it’s not just the large insurers.”
There are other areas of SSBCI where growth is lagging. Home modifications, for instance, would fit in that category, with only 52 plans offering the benefit in 2022.
Despite being a very useful service for seniors aging in place, the reimbursement aspect is a little more tricky.
“That one, in particular, may come with difficulties with contracting or reimbursement,” Rallos said. “These benefits that administratively are a little more difficult to execute may be the ones that plans are a little more cautious around.”
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