A couple of Medicare Advantage (MA) policy changes implemented earlier this year point to MA insurers as the perfect candidates to pay for senior living services as part of new supplementary benefits.
Medicare Advantage allows government Medicare dollars to go through private insurers that in turn offer seniors benefit packages as an alternative option to Original Medicare. Medicare Advantage has a history of more flexibility than traditional Medicare concerning services valuable to seniors in the form of supplementary benefits.
In a final rule issued by the Centers for Medicare and Medicaid Services (CMS) on April 2, 2018, beginning in 2019 MA insurers will be able to cover certain non-skilled in-home care. This is the first time daily maintenance is included in the allowed supplemental benefits.
It seems that the policy is set to benefit the private in-home care provider, but Senior Housing News pointed out in a report the senior housing providers that offer the settings and controls the environment make the most lucrative partners.
As more beneficiaries enroll in privately-insured Medicare Advantage plans and the push for value-based and coordinated care continue, senior living is the place where more quality outcomes can be achieved. With payers offering more incentives for quality care, payment models are shifting and most senior living providers are still on the private-pay-only model.
Anne Tomlinson, CEO of D.C. based healthcare consultant services Anne Tumlinson Innovations, said in the Senior Housing News Report, “senior housing is a great platform for providing very effective care coordination and value-based care for Medicare beneficiaries.”
Senior living providers are among the last systems to participate in the Fee for Service model, defined as anything other than being compensated for value-based care. Their situation is unique because they are in control over a resident’s environment and services being administered to them, including food and nutrition and medication management.
“It is ideal,” said Tomlinson, “You can be incredibly effective in reducing hospitalizations, in reducing [Emergency Room] use, in reducing polypharmacy use, rehab—all of the things we know from years and years of research are the cornerstones of a care coordination model are pumped up on steroids in senior housing.”
The change however, to value-based care presents challenges for senior living CEO of Juniper Communities Lynne Katzmann told Senior Housing News, “ultimately this requires a mindset shift and culture change.”
For a preview of Senior Housing News’ report, click here.
To read more about how senior living providers can benefit, click here,
And for CMS’ final rule, click here.