Helper Bees, based in Austin, Texas, is the developer of an aging-in-place platform that connects families with services in and around their homes. The company’s technology provides the infrastructure for payers to access, deploy and scale services. It has partnerships with most insurance carriers and health plans nationwide.

The helpful card works like a prepaid debit card. Payers can load money onto the card for eligible products and services. The card has distinct digital wallets for different purposes, such as buying OTC products, paying for in-home services, making retail purchases, covering health care costs, paying for utilities and covering gym memberships. This ensures that members have a smooth and complete experience.

“Historically, flex cards have been good for products, not services,” The Helper Bees COO Andy Friedell told Home Health Care News. “That is because services typically must be delivered through a credentialed network. Because of Helper Bees, our whole business model is built around a credentialed network of non-medical SDoH service providers. We are in this unique position where we can offer a card with both a retail network and a credentialed network of non-medical SDoH service providers.”

Friedell provided an example of a member who might use a flex card to purchase a grab bar for their bathroom. However, if they are a senior citizen and have it mailed to them, it is useless unless they have someone to install it.

“In our world, you can now, with the helpful card, buy a grab bar and have a credentialed, vetted handy person install it in your bathroom,” Friedell said. “You can access a grocery benefit and also get a ride to the store. It’s really a way to mix and match products and services.”

helpful stands out from traditional flexible spending cards due to its unique ability to provide members with convenience and choice through a single multi-functional card, Friedell said. It grants access to over 60,000 retail locations, including major pharmacy and grocery chains, and covers out-of-pocket healthcare expenses related to dental, vision and hearing. Furthermore, helpful connects members to The Helper Bees’ nationwide network of over 20,000 vetted home care providers.

The Helper Bees has selected Boston-based Lynx as its card provider. In addition to the flex card, the partnership offers an integrated e-commerce experience, providing a wide range of products and services on a single platform.

Lynx’s platform connects to an application programming interface (API) for health care payments, banking and e-commerce. It allows companies to integrate customizable financial technology solutions for improved affordability, increased health engagement and enhanced financial security.

“Partnering with The Helper Bees to introduce the helpful card is a testament to our commitment to modernizing the supplemental benefits space and simplifying the member experience,” Lynx CEO Matthew Renfro said in a statement. “With these benefits and services becoming increasingly important in Medicare Advantage, this collaboration ensures more seamless and efficient access.”

The card’s flexibility allows for effective fund allocation, maximizing utilization without extra costs. Members can access various options, while payers can customize choices to meet specific plan requirements and budget constraints.

helpful is accessible to all of The Helper Bees’ payer partnerships, including Medicare Advantage plans, Medicaid-managed care organizations, long-term care insurance carriers and other partners.

“The growth in these supplemental benefits has come based on the belief that non-medical services help keep members healthier and independent at home,” Friedell said. “But when they are disjointed with different vendors and different payment models, they begin to lose their value. By pulling them together into one unified experience, a plan [such as Medicare Advantage] can start to look at leveraging the dollars they’re spending on these SDoH non-medical services to affect health care and keep people healthier and independent at home longer.”

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That’s one of the key takeaways from a report conducted by Leavitt Partners, in collaboration with The Helper Bees.

Overall, over 30 million Americans are enrolled in MA plans. One of main draws of MA is the additional benefits.

Supplemental benefits are different across various plans, but typically include things like dental coverage, fitness and wellness programs, transportation services, and in-home support services, for example.

Over the years, MA supplemental benefits have expanded from a limited set of offerings to a much more ample range of benefits. Some plans have invested heavily in these benefits, while others have shied away.

“By offering a wider variety of supplemental benefits, MA plans have provided numerous seniors with personalized benefits that give them access to the services they need to live a healthier and happier life,” Leavitt Partners wrote in the report. “It has also empowered plans with the flexibility to tailor their offerings to best help members manage chronic conditions.”

The report noted that supplemental benefits have the possibility to drive value-based care. However, MA supplemental benefits need to be assessed to measure their impact. .

“Looking more broadly, the advantages and disadvantages of different MA supplemental benefit approaches are unclear given a lack of standardized data,” Leavitt Partners wrote. “The dearth of comparable data has led to little insight into what plans are offering, what beneficiaries are using, the quality of each provider of supplemental benefits, the level of variability in quality, plans’ success at overseeing these non-clinical service providers and the benefits offered, and the return on investment for the federal government.”

The report suggests that the Medicaid model is the answer.

“Medicare Advantage plans are beginning to see that it is a model that has stood the test of time, and proved reliable for getting these important services fulfilled and developed,” Andrew Friedell, COO of The Helper Bees, told Home Health Care News.

MA plans shouldn’t be scared off from offering in-home support due to the backlash the 1099 model received last year, Friedell added.

“Medicare Advantage plans were early in understanding and embracing the value of in-home support, but they came at it through a relatively new approach with the contractor — 1099 — model,” he said. “[Medicaid] has always kind of relied on that regulated agency model that the states have kind of set up around caregivers entering the home. That gives you all the protections of that state regulated model, like oversight, training and background checks and screening. It also gives you access to a broader spectrum of service options. It isn’t just companionship, but it can also be homemaker services and personal care services.”

Additionally, home care agencies could have the chance to lean into MA opportunities further if there was better data surrounding benefits.

“There are more of these hours being approved, and now they’re also being more concentrated towards that agency approach, that regulated agency framework, which is a good thing for [home care leaders] who run regulated agencies to contemplate if this a space that provides a market opportunity for them in the future,” Friedell said.

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Geoff Abraskin has been named the new president of the hospice division at Amedisys (Nasdaq: AMED). 

He has been with the company for nearly 15 years.

“Geoffrey Abraskin has been promoted to President of the Hospice Division!” Amedisys wrote in a LinkedIn post last week. “Geoff is a doctor of physical therapy and a certified wound specialist who joined Amedisys 14 years ago as an administrator and rehabilitation specialty director. He most recently served as SVP of the home health northeast region, and brings strong operational, clinical, integration, engagement and overall strategy expertise to the hospice team.”

Based in Baton Rouge, Louisiana, Amedisys is a provider of home health, hospice and high-acuity care services in the home. It has about 16,500 employees that deliver care through over 520 care centers in 37 states and the District of Columbia.

Abraskin recently sat down with Home Health Care News to chat about some of Amedisys’ recent successes.

“We’re seeing some green shoots from people applying for jobs,” he said. “We actually just had our best two months in terms of fills. We’re seeing contractor costs coming down, so that’s a big positive for us. But overall, there’s so many people that need home health today, and there’s just X number of capacity. We’re hiring more people. We just can’t hire fast enough.”

UnitedHealth Group’s (NYSE: UNH) Optum agreed to acquire Amedisys earlier this year.

Elevance Health’s Next CFO

Earlier this month, Elevance Health (NYSE: ELV) announced that CFO John Gallina would be retiring from his role as executive vice president and CFO later this year. In tandem with that news, the company announced that Mark Kaye would be taking over those positions.

Kaye was formerly the CFO at Moody’s Corporation. He will report directly to Gail Boudreaux, the president and CEO of Elevance Health. From September 6 to November 1, Kaye will serve as CFO Designate. After that, he will officially become the executive vice president and CFO of Elevance Health.

Gallina will also remain with the company as a special advisor to the CEO following his retirement. He has been at Elevance Health for nearly three decades, and was named CFO in 2016.

“On behalf of the entire Elevance Health team, I want to thank John for his contributions to our company over the last three decades,” Boudreaux said in a statement. “John has been a valued member of our organization who has successfully led our finance organization, navigated an ever-changing and dynamic health care landscape, and played an important role in our transformation to become a lifetime trusted health partner.”

Based in Indianapolis, Elevance Health is a large managed care company. It also is part provider, however, and has made in-home care a priority.

It most recently teased big plans to get more involved with at-home acute care.

“Mark is a well-respected leader with an extensive global finance background, who has significant experience in leveraging data-driven financial insight to support the execution of superior operational and strategic decisions, including growing and scaling businesses to drive success,” Boudreaux said in a statement. “With an innovative and customer first mindset coupled with his passion for fostering a high- performance culture, Mark will be a tremendous asset as we work to deliver on our purpose to improve the health of humanity.”

The Helper Bees’ Daniel Murphy joins the Family Caregiving Advisory Council

The Helper Bees announced last week that Daniel Murphy will join the federal Family Caregiving Advisory Council, which “makes recommendations to the administrator of ACL/Assistant Secretary for Aging on how to support and improve the lives of family caregivers.”

Murphy is the general manager of SaaS solutions at The Helper Bees. He previously was the co-founder and chief product officer of healthAlign, which was acquired by The Helper Bees in 2021. Before that, he served as national director of population health product and strategy for Maxim, a home health care provider.

“My experiences in the military led me to the home health care industry when I transitioned to the private sector, where I continue to serve others,” Murphy said in a statement. “I’ve spent the past decade in the aging services industry, helping families, insurance companies and policymakers deliver better care for veterans and older Americans who deserve quality care. I look forward to working with other members of the Council, advising on solutions to improve caregiving.”

Based in Austin, Texas, the Helper Bees is an insurtech company that partners with payers and home-based care providers to help coordinate care in the home.

Murphy will serve on the Family Advisory Council through 2026.

DUOS appoints chief strategy and growth officer

The home-based care startup DUOS has named Jenn Kerfoot as chief strategy and growth officer.

Kerfoot previously served as the chief experience officer at FarmboxRx.

“Coming off a stellar Series A funding close earlier this year, DUOS brings on Kerfoot at a critical time of expansion to lead all things growth, including business development, B2B sales, brand marketing and more,” the company said in a statement.

Indeed, DUOS announced in June that it raised $10 million, bringing its funding total to over $33 million. The round was led by Primetime Partners and SJF Ventures.

Based in New York, the company places personal care assistants into seniors’ homes. It also has proprietary software, which has become a larger part of its business model.

DUOS hired Tom Shankle as the company’s new VP of health solutions earlier this month.

AlayaCare brings on new SVP of customer success

AlayaCare announced that Rhonda Bosch is joining its executive leadership team as SVP of customer success.

In the her role, she will “spearhead customer success strategies and initiatives, driving unparalleled value and satisfaction for clients across the home care sector,” according to the company.

“We are delighted to welcome Rhonda to our executive team,” AlayaCare Founder and CEO Adrian Schauer said in a statement. “Her proven expertise in fostering customer relationships and driving growth aligns seamlessly with our mission to provide innovative solutions that exceed our client’s expectations.”

Previously, Bosch served as the COO of Mercatus Technologies Inc.

“I am honored to join AlayaCare and lead the customer success efforts,” Bosch said in a statement. “What drew me to AlayaCare is that our people really care. And when you care about making a difference, you really own it. AlayaCare works hard to make it easier for caregivers to be able to execute a high level of care, and I’m excited to help nurture and foster their customers to achieve better outcomes.”

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Increasingly, home care providers have become bullish on LTCI plans and the untapped opportunities they may offer.

“There’s massive potential, and they are trying to tap into it,” The Helper Bees CEO Dr. Char Hu told Home Health Care News.

While private pay and Medicaid are generally considered the two main sources of revenue for personal home care providers, long-term care insurance is set up to cover those services at a “sometimes very nice reimbursement rate,” according to Hu.

The disconnect tends to be that national health plans are not willing to procure a host of providers to partner with in such a fragmented space. That’s the gap The Helper Bees is trying to fill.

Based in Austin, Texas, The Helper Bees is an insurtech company that acts as a liaison between home care providers and health plans. It does so on the MA side – it acquired healthAlign in 2021 – as well as on the LTCI side. The company has raised over $19 million to date.

Hu wants to open up opportunity for providers broadly, but especially within LTCI. The company has a proprietary system that helps providers and caregivers find work on a regular basis, and also ensures they’re paid regularly and on time. It has a network of home care providers it works with, both in LTCI and in MA.

“The health plans have hired us to be the aggregator and we’ve gone out and built these networks,” Hu said. “Most home care agencies would love to tap into [this]. They just can’t directly through the carrier because it would be impossible from a procurement perspective.”

For home health and home care providers, one of the toughest parts about working with health plans has been communication. They often find there’s no good point of communication within the health plan for them, which is to the detriment of both parties.

Because The Helper Bees is partnering directly with these plans, and bringing a network of providers along with it, that problem has mostly dissolved. The company has an array of health plan partnerships, and though Hu could not disclose all of them, he did acknowledge it works with “three of the four biggest plans.”

“[Within] long-term care insurance, these are people paying premiums, but they’re not using any of their benefits,” Hu said. “As a whole, the claims volume is very small right now, but it’s going to increase at a quadratic rate quickly. You’re starting to see very big carriers, with very smart individuals, getting ahead of this problem – and home care providers and long-term care providers are going to be integral in this.”

Some home care providers haven’t explored MA and LTCI because of lower rates and shoddy referral consistency from health plans.

Hu says The Helper Bees can offer providers in its network a consistent referral flow, however. Plus, there’s no client acquisition cost for providers.

But, more than anything, the value proposition is about revenue diversification. Home care providers across the country are experiencing unprecedented hikes in billing rates, which is shrinking the population that can pay out of pocket for home care long term.

A steady stream of revenue from MA or LTCI offers providers a safety net of sorts, as well as an introduction to more senior populations that need home care services.

“We want to help home care providers do better business,” Hu said. “We want to help them become more lucrative, we want to help them with their staffing, and we want to help them with diversifying revenue streams. That’s generally what we’re trying to do, and we’re doing that through our partnerships with health plans.”

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The Helper Bees (THB) is smack dab in the middle of home care providers and Medicare Advantage (MA) plans.

As its network of providers and plans grow, its gaining insight into what makes these relationships work, other than its own technology platform.

Andy Friedell – the founder and CEO of healthAlign, and now COO of The Helper Bees – believes that the next policy revolution in home-based care will be due to the supplemental benefit changes made by the Centers for Medicare & Medicaid Services (CMS) within the last five years.

The Austin, Texas-based THB works with payers and providers across the country to take the complexity out of care delivery.

Friedell sat down with Home Health Care News on the latest edition of HHCN+ Talks to discuss what he’s learned about MA-home care provider relationships, and how he thinks the landscape will evolve over time.

The transcription of that conversation is below.

HHCN: Andy, let’s start with a background on you for people who may not be familiar.

Andy Friedell: I’m Andy Friedell, the chief operating officer of The Helper Bees. I’ve got about 25 years in the health care space. I started off in the pharmacy benefit manager space many years ago, moved to home care a little over a decade ago and started a company called healthAlign that was really focused on helping plans better manage a pretty diverse range of services into the home.

It grew out of experience that myself and some of my teammates had around the challenges that plans have in this space — many times challenges that they don’t necessarily see out of the gate. There’s such an incredible administrative complexity of organizing services in the home, the data visibility when you’ve got lots of different providers that all use their own systems, and then really the challenge of fulfillment is probably one of the biggest ones that impacts members.

What we’ve done is we’ve built a large network of non-medical providers all over the country. We brought them together on a common tech platform, and that company I started, healthAlign, was acquired about two years ago by The Helper Bees. It’s just been a great combination for the two of us. I met Char Hu, the CEO of The Helper Bees, probably a little over two years ago now. We were just both surprised at how we were separately trying to solve some of the same challenges for large payers organizing services into the home but coming at it from different angles.

He had focused on the long-term care insurance space. Our team had focused on Medicare Advantage. His team had done an enormous, incredible job around member engagement, member satisfaction and care concierge programs. Whereas the healthAlign team had built this infrastructure to drive fulfillment, and so together, it’s been really a best-of-both-worlds combination where we’ve been able to bring really important tools for members and case managers to organize services.

Then you get the certainty and reliability of knowing that fulfillment is going to happen by this technology that watches fulfillment in the background and helps you close that gap. It’s been great and, for me, a lot of fun getting started in this space.

When you’re working with a non-medical home care provider, are they coming to you or are you going to them?

It’s a little bit of both, but it really grew out of plans. I used to work in a big home care organization and health plans would sort of come to us for their home community-based programs. I think part of their interest was there was a hope that you could maybe solve the fulfillment challenge with a single relationship.

You have one big nationwide partner and that solves it for you. That always sounded great, but in the back of our mind, we knew that was unrealistic. That was where the origins of our approach started. We said, “Give us your programs. Make us your single point of accountability. What we can’t fulfill, we’ll organize with our networks of providers.”

We knew that no home care company, no in-home service provider, is really well-positioned to fulfill all of the needs of a big health plan and so we knew that you have to have the power of many to make it work.

You were also solving some of those logistical challenges and technological challenges for those providers. When they wanted to get in with Medicare Advantage payers — which a lot of them aren’t engaged with — you were able to solve those final steps as opposed to them having to do an overhaul to their operations.

Yes, exactly. And it really fits on both sides.

For the provider, we make it easier, but certainly for the plan as well. I think everybody intuitively knows that services in the home are valuable and important. The problem is, a member doesn’t just need rides or just need meals or home care. They need all these services to interact with each other and that’s when it becomes exponentially complicated for a health plan to think about, “I need a ride vendor, I need multiple ride vendors, I need food, I need home care. I probably need multiple home care vendors.”

Then the thinking of credentialing them all and contracting them all, recruiting them all, watching fulfillment across them all, getting them all paid, getting documentation back from all their different systems in one language that you can make sense of. That’s what we’re trying to solve.

It is really on both sides. We’re trying to make that a central platform for the plan so you can centralize a lot of those elements.

Also for the provider — we’re trying to bring health plan business to providers that maybe either chose not to work with health plans or it never even occurred to them to work with health plans in the past. The only way you do that is to just make it simple. We have very simple mechanisms for credentialing, for onboarding, for documentation and then we’re paying providers every 14 days. So as long as they’re providing our services, documenting and following the rules of our agreement, then they’re getting paid every 14 days.

Billing rates are going up so much, especially with the private-pay clientele. There’s a smaller amount of people in the country that can afford that private-pay home care for all the hours that they need. I think this is something that providers almost have to look at.

I think so as well. It’s a great place, I think, for a provider to think about diversifying their business mix. You can still be a largely private-pay provider or focus on a certain segment of the market that you’ve had success in, but it’s probably a good idea to put some chips on this space because it’s growing very rapidly. That’s what we’re trying to do: make it easy for providers to make that decision.

On the Medicare Advantage side, there are threats to those payments. CMS is calling it a slight increase, but it depends on who you talk to. Then there are overpayment clawbacks.
Basically, there are worries from Medicare Advantage plans that they’re going to be paid less moving forward in the next couple of years. Because of that, how do you think that will affect home care benefits and these plans working with providers?

I think the impact on some of these new benefits is going to be relatively small, and that’s largely because members have become aware of them. They’ve learned to expect or really want these benefits, and so plans need to have that as part of their overall benefit profile. I think when you look at these rate changes, again, I’m not an expert in all the formulas and whatnot, but I think it depends on who and what markets you’re talking to from a plan standpoint. Because it’s a combination of a lot of factors that are driving this rate conversation.

There is the rate of increase in the amount CMS is paying, but then at the same time, there is this change they’re making to some of the risk scoring methodologies in the background.

Then there is the geography variability of rates. There are a lot of factors that plans are looking at, but I don’t think they’re likely to come at this by ratcheting back some of these benefits that are really popular and that have value to the plan. I think what’s more likely is that it sort of increases the need for the plan to become really efficient or in the way it approaches these benefits. Whereas in the past, it was sort of, “We just have to add these into the mix. We have to add rides. We have to add meals. We have to add home care.”

Now I think plans are thinking about, “Alright, how do we make this work well and efficiently so that we can keep and preserve these benefits and demonstrate the value that they bring, both from a financial standpoint, and to the member as well?”

These plans, even if they need to tighten their belts a little bit financially, their main thing is they want to keep on to these members If they’re losing members, it doesn’t matter where the rates are. That’s what they can’t have happen.

Yes, for sure. I think it’s a combination of retention and a mix of services. In addition to the attractiveness of these benefits that you mentioned from a retention standpoint, I think there is the underlying value of the benefits themselves.

When you think about the value of keeping somebody in home, the value of organizing errands to pick up somebody’s medicines, the value of getting somebody a ride to their doctor’s appointment, these are relatively low costs. Relatively, from a licensure standpoint, easy interventions to engage.

They have a huge impact when you can think about if somebody is or isn’t going to take their medicine or if they are or not going to make it to their doctor appointment. I think that’s what plans were seeing.

You’re right. From a retention standpoint, there’s significant popularity around them, but part of that is just the value as well that they provide, the underlying value of some of these services.

I want to take you back now to your early days at healthAlign. Obviously, you’re still dealing with this, but what was the problem when home care providers and health plans were trying to work together? What were the barriers? What was causing things to fall through?

It’s a great question, and there are probably different barriers on each side which I can speak to.

On the health plan side, there was this idea that out of the gate, you just need to find a provider and make a provider available. A single provider available in all your markets and then you can check the box and call it done.

The reality though is, particularly in the last several years, caregiver availability for many of these services is a very real factor. There’s this idea that if you build, they will come. It’s just not the reality in home care for many services.

The reality is that, what we saw, many health plans would initiate a benefit. They would find that single provider, make the list of providers available to their case managers, members would call in and want the service, a case manager makes a connection to the one provider and basically moves on and assumes that everything is going to flow nicely from there and then the job with that benefit is done.

The reality, though, was that caregivers weren’t coming to the home or there were staffing shortages or delays. The plan didn’t know about that until maybe a month later when the member called back really annoyed and said, “Hey, you told me I was getting home care a month ago, nobody’s called me.”

That was creating a huge amount of abrasion out of the gate with members and plans around these benefits. It just underscores the reliability, the importance of fulfillment reliability, when you’re going to offer these benefits. It’s almost worse to offer a benefit like this that you can’t have than just not offer it at all because you create an expectation. If you can’t deliver on it, it’s a huge hit to your relationship with the member.

That’s what we saw early on: that importance of that fulfillment reliability. We started recruiting multiple providers in every market. Then COVID came. We had to actually look at it almost week by week, and certainly market by market, to see how many providers we felt we needed at any given market at any given time. We would see that places like upstate New York, you would need several more home care agencies to manage your referral volume than maybe you needed in Central Florida. Northern Kentucky was similar.

You have these different markets where caregiver availability was a really huge issue and you needed to bring together that kind of “power of many.”

On the provider side, I think it was more about claims. Providers just didn’t want to submit claims, they didn’t want to deal with all that. We offloaded that responsibility from those providers and said, “Here, here’s a link. Here’s a simple page, upload your documents, your license, your insurance, your policies.”

Then we told them to manage through this agreement with us. We told them, “When we give you a referral, you reach out to the member in 48 hours or less. You start services in a certain number of days. As long as you do that, you’re going to get paid from us every 14 days.”

How has that evolved over time compared to what you were doing, let’s say three or four years ago, now that you’re with The Helper Bees? How have things evolved? What have you seen in terms of improvements? Are providers and the plans improving in terms of what they know about each other and how they’re working together?

Yes. One thing that I stumbled across in our data recently, which blew my mind, I’ll share it with you.

There’s been a change in the last few years in some of these benefits evolving from what I would call case manager-directed to more member-directed. Case manager-directed means a case manager would say, “I want to approve a member for 48 hours of home care or 60 hours of home care or a certain number of visits.”

That was what the member got. That was the benefit. Member-directed is, many times, the member is getting a wallet and they’re making decisions. “Do I want to spend this on home care rides, handyman meals, etc.?”

What we saw is really incredibly interesting. When you look at the same exact service, just look at home care, when it’s a member-directed versus a case manager-directed benefit, the fulfillment rate is completely different.

Case manager-directed home care benefits, we see fulfillment probably in the 45% range. Member-directed, 75% to 80% of those benefits are getting fulfilled to the member. It just really speaks to the member being more invested in the process. The member is saying, “I know I want this service, in this amount, at this time, and I’m going to order it now. I’m going to see that through to completion.” Versus a case manager just bestowing on you some number of hours that you may or may not feel you want.

That’s really interesting and I appreciate you sharing that data. The fulfillment with the case managers, can you explain further why there may not be a great fulfillment rate? Is it just because the members may not have prescribed it for themselves so they’re not necessarily engaged?

Yes. It’s a great question. Just to be clear — this is not at all in any way a knock on the case manager. This is just a byproduct of how we are allocating the services to the member. Some of these are the case manager playing a gatekeeper role and they’re saying, “OK, Andrew, you’re approved for 60 hours of home care.”

You might feel like that’s what you need or you might not. You may have just taken it in your conversation with a case manager, but you’re not terribly invested in it the same way you are if I say, “Andrew, here’s $300. Here’s a website, or here’s a care concierge number, you call and you make decisions on which of these services from this menu you want and when you want them.”

It’s that simple change of putting you in the driver’s seat. That has a huge impact and almost doubles the fulfillment rate of the services. A lot of times, the challenge of getting home care into the home is just making the connection between the agency and the member, securing the date and making it all scheduled to happen. When you’ve placed the order, you’re like, “I want it now.” That whole barrier is taken off the table and it’s just enabling a much simpler transition into getting services started.

Since you joined Helper Bees, is there anything that’s changed in terms of your processes, or is it the same but just embedded in a larger company?

Changes have definitely come about. There’s the combination of our products, but then there’s the combination of two teams that, when they work together, has been like one plus one equals three or four. Combining services, as I said earlier, Helper Bees had just done a really great job building out member experience, member engagement tools and care concierge benefits.

Right away, we were able to build that into one of our engagements with an MA plan. We turned that on at the start of 2022 and it had a huge impact on that plan, their population and our ability to engage the members. That honestly was a big factor in driving that fulfillment rate I talked about. Getting a team of people who get on the phone with a member, talk to them and really handhold these services to start made a huge difference. That’s been great.

I had a lot of respect for the investment in data analytics. It’s Char’s background, and he had invested a great deal there. That has allowed us more resources to be able to capture the information, make sense of and analyze the information that’s coming out of the home. That has been great.

Have you noticed that plans are more engaged in the idea of wanting to get home care for the members? That home care providers are more engaged in working with MA plans and members are more engaged in trying to get their own home care?

Yes, we see it at two different levels. There’s that publicly available information that’s out there. You see some of the reports. ATI Advisory does a great job. There are others that put out really great information on the progression of these benefits.

You look at in-home supports benefit. I think it started in 2019. It started with like 50 plans, then went to 200 plans, 400 plans, 700 plans, 1,000 plans. You see that growth in that publicly available information.

What we see behind the scenes is another level of growth that is, in addition to the plans that are adding the benefits, we’re seeing what we think of as an internal adoption rate of these benefits as well. I think, in some ways, it’s exceeding that ramp-up I just mentioned because what percent of the population are being referred into these programs? It was nominal out of the gate, then it was a half a percent, coming up to a percent.

It’s now several percentage points of members across the whole are getting these benefits. How much of the benefits are they using? Again, it’s ramping up. I think that’s being driven by internal adoption, which is due to case managers who are now familiar with these benefits. They know how to use them. They know how to bring them into the conversation with their members.

Members, I think, are starting to understand these benefits and appreciate the role that they play and really wanting to look for health plans that have good combinations of in-home support services.

I also assume that utilization begets utilization. The more this is delivered on, the more in-home care is happening, the more people want it and also the better at delivering it these providers and plans are.

That is for sure. We see that all the time. The members who are familiar with the benefit are the members who are going to now engage it more regularly.

A few years ago, you told me that as these Medicare Advantage regulatory changes were akin to when Medicaid began paying for home- and community-based services. Could you explain that further?

It’s a really interesting comparison. I think people should be paying more attention to it because it is the driver and why Medicare is looking at what it’s looking at now. Think about Medicaid. Medicaid, you go back to several decades back, early ’80s, the amount of spend that Medicaid was spending in the home was zero.

There were no dollars being spent on services in the home, but you had these seemingly small policy changes that took place in 1981, ’82, that allowed for the first states to introduce these waiver programs for home- and community-based services. Again, if you and I could go back to that point in time and have this conversation then around that, we’d probably be answering the same thing about, “Oh, is this really going to catch on? Are these really going to take root?”

Again, it was a seemingly small change. If you just looked at one waiver program in one state in one really small population dollar amount, you would not have seen this huge groundswell that follows that. In the several decades that have passed since then, what happened was the total share that Medicaid was spending on long-term care went from 0% to more than 50%. The institutional and home care spend just flipped. You just saw that ramp up.

The really, really, really interesting piece about it is — during that exact same period — the share of all Medicaid spend that it was spending on long-term care went from like half down to a third. That’s the really interesting outcome of all this. It means that, not only was it great for members getting services in the home, it was a great deal for the federal government and for the states. By making these policy changes, they effectively rearranged the program dollars and made room for the program to spend dollars elsewhere.

They got value out of that home- and community-based spend that I think people don’t look and see and understand how important that is. Fast forward today, these seemingly small policy changes are opening the door to some of these in-home support services in 2019. Then SSBCI in 2020 was allowed. You have the VBID models that were introduced and now expanded. You’ve got some of the changes like the GAO report came out recently looking at the importance of encounter documentation of these services into the home.

There are lot of things that are going on that, in my mind, are really the moving pieces coming together for Medicare. How do you carve these services into the revenue model so that they become a component of the member’s profile the same way it is with Medicaid? Medicaid looks at the member, and they value these services because they’re trying to care for the whole member. They recognize the social components as an important part of the member’s health.

They want us to understand that, invest in that, and better manage that, but then they also know there’s just value of care in the home. I think Medicare is starting to see that as well. But really, it’ll be important for the documentation to be correct and available and for CMS to be able to start to capture that information so they can demonstrate the value.

That’s where we’ll become the real catalyst on bringing these into the program once CMS has created the environment to measure the value of them. The changes you’re seeing right now are CMS setting the stage for being able to better measure the value of these investments.

The reason I ask this is because I think it’s so interesting and also important to keep that positive, long-term view because they’re still relatively new, these benefits. So obviously there’s going to be pain points, things are going to have to be worked through. I think if that is the case, providers will probably want to get involved now, if they aren’t already, then when this is more ubiquitous in two to three years.

Yes. I think it’s definitely where this is going. I think the VBID model is particularly interesting. Plans increasingly adopting it and CMS extending it out further are really indicators of that because it’s really giving plans the incentive not just to think about ways to introduce these services for certain populations, but also to require that they be tied to value.

That’s going to drive better encounter documentation. That’s going to drive better efficiency and organization of these benefits. Honestly, that’s where we see our opportunity at Helper Bees because that’s the solution we are trying to bring to this space. We’re all about helping plans. I think 2.0 of these services is all about efficiency and better documentation and more reliable fulfillment. That’s completely what our model’s geared towards.

You work with a lot of plans. What are the ones that you know are really easy to work with for both you and home care providers? What’s their approach? What’s their attitude like?

We just went live this year with a really large nationwide MA plan. Char and I, we would speculate on our side what caused them to pick a small company in Austin to do this rather than doing it themselves. What we heard from them was that they saw the challenges that some of their competitors were having in trying to organize several single endpoint solution providers, challenges from an administrative standpoint, challenges from data, challenges from fulfillment.

They saw that and they wanted to take a better approach and, at the same time, they saw and liked the value of our ability to aggregate information up across a lot of providers. Whether it’s a handyman working out of a truck, a pest control exterminator coming or a home care agency with their local branch, all of those need to bring documentation back to the plan in a way that can be aggregated together. That’s what we do.

I think our success with plans has been around plans that want or see this landscape evolving and recognize the value of a platform that brings multiple services together and allows aggregate documentation visibility across lots of different services.

On the other side, what are the providers doing now better than they may have before, or what are the best ones recognizing in terms of these relationships between plans and themselves?

That goes back to where you and I started. Whether or not you’re a provider, how do you want to play in this space? Year 2023 is not going to make or break this business, but it’s worth putting some chips on this space. What’s gone well are providers who maybe dedicated a few caregivers to these MA services because it can be a little bit different. It can be almost like an intermittent home care because the visit length is sometimes dictated by what the member wants at that time.

There can be different variability in that. We’ve had success where we have found care agencies that wanted to dedicate a couple of caregivers to this business specifically.

Interestingly, we found them because our platform scores providers. We rank providers based on how well they do in our environment, how much of what we assign do they accept, how quickly are they getting in the homes starting service. It reinforces future referrals to those that have done well in the past.

That’s actually how we found some of our best providers. The system found those for us. We found a local franchisee down in Southern California. We found a woman and her husband, who run a great agency franchisees in the Central Florida area, really just because our system was scoring and reinforcing. Then suddenly, you look in and you see that providers who have dedicated a small mix of their caregivers to us had a huge share of our volume.

We would scratch our heads and say, “We’ve got to look in and figure out why are these individual providers suddenly appearing in our system with so much share?” It was because they were approaching the business a little bit differently.

They were saying, “I want to invest in this space. I’m going to put a few caregivers on it.” They were putting one caregiver on it initially because our system was reinforcing it. Then they were putting two, three, four. Suddenly, they had a good share of their business coming through this relationship with us.

That’s a positive feedback loop. The more that you put into it, the more you’re going to get out of it down the line. I assume, too, that the technology that you’re working on at Helper Bees is also one of the biggest drivers of this.

Yes, for sure. You’ve got to make it as easy as possible for these two parties to work together in order to enable this to succeed. That is honestly what we’re trying to drive. You and I have had conversations in the past about conveners and I know there’s mixed views on that word. We look at our role entirely as enabling easier access to these services.

We don’t play a role in utilization compression. We are always trying to get the best deal, but our role is not predominantly rate compression. It is really about creating easier access points for plans and these social service providers to be able to work together.

What would keep this trend from continuing, if anything?

I talk to our team about that frequently and it’s hard to see what could keep it from continuing because you look at that Medicaid history, you look at the value of services in the home, value from the standpoint of what the member wants, what’s best from a health care standpoint and what’s best from a cost standpoint.

All signs point towards wanting to have better organization of more services into the home. It’s hard for me to see something that would turn this direction around. I think the key thing is it’s got to become better managed and better organized. I think the initial phase of these benefits being brought in by MA plans was a land grab. It was like, how simply and quickly can we turn on these new benefits to be offering something that’s attractive in the marketplace?

2.0 of that trend is us really now coming and helping plans rationalize these benefits in a better way. Make them easier, more organized, manage fulfillment better, make better connection points with more services through single channels. That’s where we see it. That I think has to happen. Big health plans are doing that now.

They are investing in technology that’s going to watch and redirect fulfillment across a large network of providers, and that’s going to standardize counter documentation from a diverse range of services as well. I think that’s the way to solve for that. That will then accelerate this trend I think further.

What’s one prediction that you have for the space?

I do think these signals you’re getting out of CMS right now, there’s speculation. Is it revisionist thinking on the supplemental benefits? I don’t read it that way. I look at it like CMS is bringing together the components that they’re going to want to see in order to tie value to these services, which is what they’ve done in the past and absolutely what they should be doing here as well.

When they’re looking at that GAO report on encounter documentation, that’s just an indication of recognition that this is really important. You can’t tie value to something if you don’t document it well. The fact that CMS wants to see better encounter documentation, I see as a good sign. I see it as they’re wanting to find the pathway for their ability to invest further in this space.

I think you’ll see change coming down the pike. I think you will see CMS moving in that direction, and it’ll bring Medicare to a spot where it’s looking at bringing that whole person set of factors into the calculation of member risk and member reimbursement and paying plans for, not just somebody who has a complex medical condition, but maybe helping recognize somebody who’s got a complex set of medical and social conditions that interplay with each other.

The post Why Certain Home Care Providers Are Seeing Success In Medicare Advantage appeared first on Home Health Care News.

Home care providers have complained about Medicare Advantage (MA) becoming a more mainstream payer source.

Still, many have begun to work with MA plans for the first time over the past few years. But now, there’s concern that the government’s crackdown on MA could restrict opportunities even further, particularly when it comes to supplemental benefits.

“There’s no question that the recently proposed risk-adjustment policy would reduce payments enough that plans would certainly reduce supplemental benefit offerings,” ATI Advisory founder and CEO Anne Tumlinson told HHCN in an email.

Specifically, the U.S. Centers for Medicare & Medicaid Services (CMS) is attempting to cut plans’ payment rate by 2.27%. CMS is also hoping to regain billions of dollars in overpayments from major insurers in the near-term future.

That, some believe, could mean that plans are “less generous” with the supplemental benefits they offer. Health Affairs covered the issue in an analysis published Wednesday.

“Concerns that … plans are overpaid have motivated calls to reduce MA benchmarks – the dollar amounts set by [CMS] against which MA plans bid to set premiums and fund extra benefits,” the Health Affairs analysis states. “However, cutting benchmarks may lead to higher MA enrollee premiums and decreased plan generosity.”

Home Health Care News explores this issue and the possible impact to home care providers in this week’s exclusive, members-only HHCN+ Update.

Trickle-down effect

CMS’ approach to the most recent MA payment rule is similar to how the agency approached the CY2023 final rule for home health agencies. Home health providers are seeing a 4% decrease to aggregate payments this year, but with other factors included, a 0.7% “bump”.

From the MA plan perspective, CMS is cutting rates by 2.27% in 2024, though the agency argues payments will increase by about 1%.

What matters is whether plans see their final payment rule as cause for a financial belt tightening. That possible cut is also on top of promised increased oversight and potential clawbacks for overpayments. CMS will reportedly ask major health insurers to give back about $4.7 billion in overpayments to start.

The question: Will this revenue hit mean less room for home care providers within the supplemental benefits structure?

Newer supplemental benefits fall into two categories: Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI). The amount of plans offering these benefits has skyrocketed over the past few years.

Benefits such as in-home support services (IHSS), among others, are where home care providers have been able to step in.

“You have to put these [payment] reductions in the larger context that growth in plan payments over recent years has certainly fueled much of the rapid growth in the new non-medical supplemental benefit offerings, particularly for in-home support services,” Tumlinson said.

IHSS has been one of the most popular benefits. There has been a 364% increase in plans offering the benefit since 2020, from 283 plans then to 1,314 in 2023. There has also been a 320% increase in plans offering caregiver support services, another supplemental benefit.

The per member, per month average for plan spending on supplemental benefits increased from $36 in 2022 to $50 in 2023, according to the Medicare Payment Advisory Commission (MedPAC). Rebates paid by the government to MA plans, which the plans used to fund enhanced benefits, also grew 53% between 2019 and 2022, according to Health Affairs.

Supplemental benefits’ future

Given the steady payment environment that has benefited MA plans over the course of the past few years, supplemental benefits should not be on the immediate chopping block.

“I think there’s room to cut some before it has a significant impact on supplemental benefit offerings and out-of-pocket costs,” Tumlinson said. “Plans do not want to lose enrollment and they are competing not just against each other, but against the open networks of original Medicare fee-for-service, so they’ll probably accept some margin compression before they give up lives.”

Indeed, supplemental benefits are a key differentiator MA plans have to tout over Medicare fee for service. Personal home care, for instance, is not available under the traditional Medicare benefit.

Tumlinson foresees a benefit-offering slowdown, but with a caveat.

“What you would see is that plans already offering these benefits would keep offering them because they are so meaningful to the people using them,” she said. “But you would see a significant slow-down in the number of new plans coming to market offering them going forward.”

The data backs up Tumlinson’s assertion. The aforementioned Health Affairs study – which focused on supplemental benefits, but not home-based care ones specifically – concluded that CMS’ MA changes would “decrease plan generosity,” but only modestly.

The propensity to offer benefits would generally decline by less than 5 percentage points, according to Health Affairs, with the greatest impact being on the availability of dental, hearing and vision benefits.

Helper Bees COO Andy Friedell – who works in the middle of plans and home care providers – believes the same.

“The evidence implies the effect on benefits is modest,” Friedell said. “That’s in part because members really want, or now expect, many of these services. So, this requires the plans to be significantly more efficient with how they administer and track these benefits.”

The Helper Bees works with MA plans and providers to make the process of deploying in-home care more seamless.

“Not all supplemental benefit programs are created equal,” Friedell said. “And when it comes to in-home programs, ‘If you build it, they will come,’ isn’t always true. Fulfillment consistency and reliability are very real challenges for many families.”

Ultimately, supplemental benefits and in-home offerings represent competitive advantages for MA plans, against each other and against Medicare fee for service.

For the home care providers that have invested time and resources into getting into MA beneficiaries’ homes, panic is not yet warranted. In the end, health care is moving further into the home, whether CMS is handing out rate increases to MA plans or not.

The post With MA Cuts Coming, Home Care Supplemental Benefits Hang In The Balance appeared first on Home Health Care News.

Changes have allowed MA plans to pay for additional at-home services, whether through primarily health-related benefits or Special Supplemental Benefits for the Chronically Ill (SSBCI).

Those changes aren’t major on the surface, and adoption hasn’t been as swift as some would like. But that shouldn’t deter MA interest for home-based care providers, Andy Friedell, the founder and CEO of healthAlign, said at the Home Health Care News Home Care Conference in December. 

“We have pretty good insight into what you see take place over a period of time when these public policy changes occur,” Friedell said. “And to us, while this was a seemingly small change in the Medicare regulations, allowing more flexibility for MA plans to offer some of these services at home … can create a huge shift over time.”

healthAlign is a convener of home-based care services. Essentially, it has a platform that enables payers to interact with a slew of home-based care providers at once – and it makes those relationships more seamless.

Traditionally, Medicaid was the healthAlign team’s focus. That has changed with the amendments made to MA.  

“Our history was mostly on the Medicaid side, in home care,” Friedell said. “And so we had a really good perspective on the services that are required or needed for a member who has long-term care needs and wants to stay at home.”

Friedell points to Medicaid as evidence for his bullishness on MA. When similar doors were opened for Medicaid in the 1980s, it went largely unnoticed. But over time, it’s created a huge shift in the kind of services Medicaid pays for.

“If you go back several decades, there was a time where Medicaid did not pay for any services in the home,” he said. “And there was this seemingly small change in a pretty obscure piece of legislation in the early 1980s that Congress enacted. At the time, it didn’t get the attention it may have deserved. But it opened the door for Medicaid to start covering services in the home.”

Since, home-based services have gone from having a 0% share spend in Medicaid to over 60%, where it has now surpassed institutional spend.

“At the same time, the overall share of long-term care spending in Medicaid went from over half of its spending to under a third,” Friedell said. “So what that means is that Medicaid, it experienced some public policy changes, and it created these benefits in the home. And ultimately, it had the effect of essentially creating room for the program to spend more dollars elsewhere.”

The federal government – in shifting more care into the home – has seen a sizable return on its investment.

healthAlign’s dedication to the home and the MA shift led to a similar company – The Helper Bees (THB) – acquiring it in May. Traditionally a long-term care convener, THB saw value in creating a convener platform that was enabled across the continuum.

On Jan. 11, The Helper Bees announced it closed $12.8 million in Series B funding, led by Trust Ventures. That comes on the heels of what the company called “significant growth,” in part due to the healthAlign acquisition.

THB plans to use the funding to expand its aging-in-place marketplace.

What The Helper Bees and healthAlign are betting on is that a looming shift in MA will mirror that of Medicaid’s. Plus, tailwinds created by COVID-19 should undoubtedly speed up that shift, in their minds.

“That’s what we talk about when we engage with some of our providers – not to look at it from this point in time, and at the seemingly small changes today,” Friedell said. “We see it as kind of opening the door for a similar trajectory of incremental adoption. Certainly, the long-term return on investment that we expect is like the one [providers saw] in Medicaid.”

Close to 15% of MA plans will offer primarily health-related in-home support services in 2022. Meanwhile, the amount of plans with SSBCI offerings has seen a significant increase, according to a recent report from ATI Advisory.

In 2022, nearly 1,300 MA plans will be offering SSBCI. Hundreds of plans will offer benefits crafted around social support and “general supports for living.”

“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, previously 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.”

It isn’t just about adoption of the benefits, either.

Plans are also allowing more paid hours for at-home services within their benefits, according to Friedell. 

“We had one of the first contracts with a nationwide MA plan to offer one of these benefits back in 2019,” he said. “I would say at that point in time, the volume and utilization of service was negligible. There was really not a lot of usage of that service. But then in 2020, it really came out strong. There was a huge growth of adoption, hours and members using these new benefits. In 2022, we will see probably close to a four-fold increase again on adoption of these services.”

Plans used to offer a low, fixed number of visits or hours for at-home benefits. But that’s beginning to change.

“What we’re seeing going into next year is plans starting to think about and recognize that this really limits both the case manager and the member, because members’ needs are constantly changing,” Friedell said. “They’re starting to look at ways to use value instead of fixed numbers. … Giving members that kind of additional flexibility, I think that’s another big change that we’re just starting to see. And that’s good for the member [and providers].”

The post Why In-Home Care Providers Shouldn’t Scrap MA Strategies Over Lagging Results appeared first on Home Health Care News.

TruBlue Total House Care, for example, has formed a partnership with The Helper Bees. As part of the arrangement, TruBlue’s services will be offered in market areas where The Helper Bees’ health plan partners and members are eligible.

“The overall goal is to help seniors age in place safely, successfully,” Sean Fitzgerald, the president of TruBlue, told Home Health Care News.

Cincinnati, Ohio-based TruBlue is a senior-focused home repair company that operates under a franchising business model. TruBlue specializes in house care, home maintenance and safety modifications.

Austin, Texas-based The Helper Bees works with large insurance companies and others to help with claims processing. It works with both long-term care insurance players and Medicare Advantage (MA) plans, with its services available across all 50 states and Puerto Rico.

In August, The Helper Bees acquired healthAlign, an administration and fulfillment platform. The deal allowed The Helper Bees to bring together a range of providers — such as in-home care agencies, home modification businesses, meal-assistance services and others — onto one platform.

It’s through healthAlign that The Helper Bees and TruBlue came together.

healthAlign works with MA plans to help them manage some of the newer supplemental benefits they’ve rolled out over the last few years, such as in-home support. The Helper Bees deal with TruBlue helped the company beef up these services, Andy Friedell, CEO at healthAlign, told HHCN.

“We had to think about broadening our network to be more than just home care companies, but also include some of these more diverse services that many members need in order to age in place safely at home,” Friedell said. “Home modification was a really prime example of that. It just made sense to find a really quality nationwide partner who had developed a specific specialty in this market.”

Indeed, TruBlue’s specialized focus and experience in aging services made the company an attractive partner. Over the years, the company has also teamed up with senior care companies such as Right at Home.

“There are a lot of contractors and handyman support in and around the home, but TruBlue has focused very much on the older American population,” Friedell said. “There is a range of very specific needs, projects, investments and upgrades this population can benefit from in order to maintain their independence at home.”

The partnership also made strategic sense for TruBlue.

“They’re a very large organization, and they have a great network already,” Fitzgerald said. “Plus, a significant amount of our franchisees are in those areas that they’re providing services. It gives us an opportunity to provide services that our franchisees can benefit from.”

Making strategic sense

The formation of these partnerships makes sense on several levels.

Roughly 77% of people 50 and older would like to stay in their current home as long as possible. Despite this, less than 1% of U.S. homes have particular features needed to support aging in the home, according to AARP.

The problem of homes not being set up for aging in place is often underscored when falls occur. It’s estimated that falls cost over $50 billion a year in medical expenses, and individuals over 65 have a 10% annual probability of suffering a serious fall costing an average of $11,500 in related expenses.

Another collaboration that is focused on home modifications in relation to aging in place is one between home improvement retail company Lowe’s and AARP.

Lowe’s recently announced the launch of “Lowe’s Livable Home,” which offers senior-focused home modification services. The company’s goal is to become a “one-stop destination for universal design options.”

In order to accomplish this, Lowe’s associates and managers will receive training from AARP. The training will focus on practical skills and information to support seniors looking to improve their home.

“There’s this big gap between the homes we have and homes we need,” Rodney Harrell, vice president for family, home and community at AARP, told HHCN. “What Lowe’s provides us is a way to help homeowners … make the changes that they need [to their homes].”

As a company that, prior to this launch, worked outside of aging service, Lowe’s brings a fresh perspective, according to Harrell.

“We cannot just rely on the network of senior aging facilities, senior specialists and the like to really fully address this societal gap we’re talking about,” he said. “There’s an important role for those organizations, but there’s also an important role for designers, builders, architects and home-improvement stores. I view this as an all-hands-on-deck kind of an issue, one where we need everyone connected to homes, care and the people in them on board.”

While AARP has always made a point to collaborate with organizations outside of senior care and aging services, Harrell believes that relationships like the one with Lowe’s will become more common as a response to the U.S. aging population.

“As designers, builders and others are thinking about how to create homes, they’ll be looking for expertise in dealing with and working for people of all ages,” he said. “It’s only natural. They see the demographic shift that’s happening.”

The post Beyond Senior Care: Why Nontraditional Partnerships Are Critical for Aging in Place appeared first on Home Health Care News.

Broadly, Austin, Texas-based The Helper Bees works with large insurance companies to help these organizations with claims processing.

“Our mission and goals as a company are to use tech-enabled services to keep older adults independent at home for as long as possible,” Char Hu, CEO of The Helper Bees, told Home Health Care News. “All of our services are deployed specifically through large payers. That means when their insurers usually file a claim to access aging-in-place related services, that’s when we get involved. We deliver a high-quality service backed by data and technology in order to reduce the exposure for the insurance carrier.”

The company works with both long-term care insurance players and MA plans. Its services are available across all 50 states and Puerto Rico.

The Helpers Bees’ new aging-in-place marketplace gives members of MA plans, for example, access to all the supplemental benefits that a plan might offer in one spot.

“Medicare Advantage has layered on quite a few of these really great benefits, supplemental benefits, but what ends up happening oftentimes is, say, you have six different benefits,” Hu said. “You as a member might have to [go] through care management, or directly [contact] six different particular vendors. The platform or marketplace allows access to all six benefits through one conduit.”

Plus, the company handles the claims, the credits and the payments for all those services — filing claims on behalf of the providers.

Another value-add of The Helpers Bees marketplace is that it significantly reduces the administrative burden on health plans.

“It’s more expensive for the plan to go through all these hundreds of different vendors for each of the benefits,” Hu said.

The company’s marketplace also allows providers that may be new to interacting with health plans, including in some cases personal care agencies, to bill for their services and be reimbursed.

“It opens up the door for quite a few different aging-in-place services providers to access a new revenue stream,” Hu said. “Home care agencies want to access MA plans and long-term care insurance plans. All of those great agencies out there can’t strike a contract with the plans because that would be tens of thousands of contracts. The MA plan contracts with us, and we contract with tens of thousands of providers. The home care agencies have access to the MA referrals, and customers, just through our platform.”

The Helper Bees is connecting home care agencies directly with customers that have reimbursable insurance policies, MA and long-term care insurance.

“This is in stark contrast to other common referral sources that do not include payment qualification or verification,” Hu said.

The launch of The Helper Bees marketplace has its roots in the company acquisition of healthAlign, an administration and fulfillment platform, in August.

Specifically, the healthAlign deal allowed The Helper Bees to step into the MA space.

“healthAlign had one of the first contracts to be this aggregator of services and deliver Medicare Advantage referrals to home care agencies back in 2019,” Hu said. “The acquisition gave us a great new platform within Medicare Advantage to distribute some of our services. It also allowed us to bring some of those MA services down into long-term care insurance.”

Overall, healthAlign has a growing MA business. The company has gone from roughly a dozen health plans in 2019 to over 200 projected for the start of 2022.

Purchasing healthAlign has allowed The Helper Bees to fuel its growth plans.

“We have pretty significant growth plans within Medicare Advantage and Medicare as a whole,” Hu said. “That’s the benefit of acquiring healthAlign and giving them access to our scale. … We can drive much higher fulfillment, and that’s great for home care agencies.”

As The Helper Bees continues to grow, it has been important not to sacrifice quality for growth, according to Hu.

“We’ve excelled at that, as a team and as a company,” he said. “One of our main focuses next year is to expand the marketplace. This is unique; instead of an individual having to Google or ask your neighbor for what might work, they can access through their insurance plan, their group benefit plan, their employer plan, a marketplace of curated and credential providers delivering services that keep them at home.”

The post Aging-in-Place Marketplace Opening New Medicare Advantage Doors for Home Care Agencies appeared first on Home Health Care News.

Austin, Texas-based THB is a full-service insurtech company that works to create innovative aging-in-place solutions for both payers and consumers. THB’s new marketplace — the next evolution of its “Care Concierge” program — is designed to give individuals in need of home care and other aging-in-place services direct access through a self-serve portal.

“I often pose the question ‘what does it really take to live and age in place?’” THB CEO Char Hu said in a press release announcing the news. “The truth is that the answer changes over time, and from individual to individual. This makes it extremely difficult to organize, deploy and scale in-home service offerings.”

Over 5,000 credentialed providers are part of the marketplace, according to THB.

In addition to consumers of aging-in place services, the marketplace is also meant to help payers, which sometimes hit difficulties finding in-home care providers in certain areas due to the market’s highly fragmented nature. Both payers and consumers can use the marketplace to shop for a range of available services, either independently or through THB’s Care Concierge program.

Services are paid for through a “digital wallet of credits,” according to THB. Credits can be secured by Medicare Advantage (MA) plans, Medicaid organizations and PACE programs, or through private-pay services such as long-term care insurance, group plans, value-added services and employer-sponsored markets.

The aging-in-place provider marketplace is made possible by THB’s May acquisition of healthAlign, the company noted.

Similar to THB, healthAlign offers a data-driven platform to health plan and provider partners. Often, the business functions as a convener, but with a particular focus on home care.

“This one-of-a-kind combination of a member-focused team with a smart network platform enables payers to better manage all aspects of in-home programming,” Andy Friedell, founder and CEO of healthAlign, said in the release. “It’s very difficult to organize different services into the home, and even harder to get good data back from those interactions.”

THB and healthAlign have seen their businesses buoyed by the gradual expansion of MA supplemental benefits. The trend started in April 2018, when the U.S. Centers for Medicare & Medicaid Services (CMS) announced that MA plans could offer “non-skilled in-home care” as a supplemental benefit in certain scenarios.

CMS made a similar but separate expansion the following year.

healthAlign’s MA business has grown from about a dozen health plans in 2019 to over 200 projected for the start of 2022.

Currently, THB and healthAlign “manage over a million and half hours of in-home services annually,” according to the press release.

“When the plan is dealing with lots of individual providers, they are creating lots of channels,” Friedell previously told Home Health Care News. “Each one of those channels is limited by that individual provider’s service offerings, as well as that provider’s fulfillment capabilities. We’re trying to give the plan one channel where they can recruit and credential providers so they can then make matches in the database between services and zip codes. Then, they can start pulling data back in a normalized format — as opposed to from lots of different systems and formats — and get everybody paid on one mechanism as well.”

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