ATI Advisory

What Home Care Operators Can Expect from MA Plans in 2022

October is normally a pretty eventful time for home health and home care operators. This year will certainly be no different, particularly when it comes to emerging Medicare Advantage (MA) opportunities. As Medicare-certified home health agencies await the final payment rule that comes out at the end of October, home care companies will be closely …

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Increasing LTSS Access Could Cost Up to $12.8 Billion Per Year

Access to long-term services and supports (LTSS) in the U.S. remains limited, which currently puts seniors in need in a bind. Their options are often such: spend down on savings and assets in order to qualify for Medicaid, or rely on unpaid family care or other informal services. A new study from the Washington, D.C.-based …

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Why Home Care Providers Should Stand Strong in Negotiations with MA Plans

Home care companies looking to lean into Medicare Advantage (MA) opportunities in their markets will have to plan prudently. That planning must be pretty comprehensive, too, as there’s no silver bullet to winning MA business. That’s according to ATI Advisory founder and CEO Anne Tumlinson, who spoke at the Home Health Care News Medicare Advantage …

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Smaller MA Plans Are Leveraging the Home to Get Ahead

The Medicare Advantage (MA) market is controlled mostly by big payers, as the top 10 plans control over 75% of the market. Then there is a 50-foot cliff. Yet at the bottom of that cliff, there are the smaller MA payers who are often more willing to explore and innovate to stand out. Examples of …

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Direct-Contracting Entities Figuring Out How to Capitalize on Competitive Advantage

A delay in the Global and Professional Direct Contracting Model by the Biden administration has put the already-accepted direct-contracting entities (DCEs) in a coveted position. New entrants are no longer being accepted for participation in the model while the Centers for Medicare & Medicaid Services (CMS) and its innovation arm review the details. That gives …

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In-Home Care Providers Must Break Through Barriers to Handle More Long-Term Care Volume

There are several trends shaping senior care in the United States, with two of the biggest being continued Medicare Advantage (MA) growth and the steady shift of health care into the home. Yet if in-home care operators want to capitalize on those trends, they’ll have to break through traditional payment and operational barriers. That’s particularly …

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Pause to Alternative Payment Models Gives Some Providers a ‘Golden Ticket,’ Leaves Others Behind

The Global and Professional Direct Contracting Model — a Center for Medicare & Medicaid Innovation (CMMI) creation — has been put on pause. The holdup is just another example of CMMI pumping the brakes on an alternative payment model in the days since the new Biden administration took over the executive branch. Broadly, the Global …

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‘There Is Not An Easy Solution’: How to Modernize Home- and Community-Based Services

Home-based care insiders have been saying for a long time what a wider group of people are now: Care needs to be brought into the home more frequently — and quickly. But accomplishing that won’t be so simple. In fact, turning the nation’s long-term care system into one that allows more seniors to age in …

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Not a ‘Temporary Blip’: Home Health Agencies Gaining Greater Share of Hospital Discharges

The anecdotal claims from home health insiders were true: Across the country, home health agencies gained a greater share of discharges from short-term acute care hospitals during the public health emergency. Specifically, the percentage of patients discharged into home health care rose 1.8% from March to May of 2020, from 17% to 18.8%. That would …

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Number of MA Plans Offering SSBCI ‘Social Needs Benefit’ Up 568% in 2021

In September, the U.S. Centers for Medicare & Medicaid Services (CMS) released high-level data suggesting a huge expansion of new Medicare Advantage (MA) supplemental benefits for 2021. CMS followed that up with specific information on MA supplemental benefits under the “primarily health-related” pathway a month later, catching home care providers’ attention due to strong numbers …

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New Data Confirms More Patients Are Being Discharged to Home Health Agencies

Patients discharged from hospitals are increasingly headed to home health agencies, a new analysis from ATI Advisory shows. In May 2019, of the 801,464 patients discharged from short-term acute care hospitals (STACHs), 11% were sent to home health agencies. In May 2020, of the 558,296 patients discharged from STACHs, 19% went to home health agencies. …

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UnitedHealthcare Advances Home Strategy, Expects to Make 1.7M House Calls in 2020

A number of major Medicare Advantage (MA) carriers are expanding their supplemental benefit offerings shaped around in-home care next year. UnitedHealthcare, the insurance arm of UnitedHealth Group (NYSE: UNH), is among them. Overall, UnitedHealthcare partners with more than 1.3 million physicians and care professionals across the U.S., plus another 6,500 or so hospitals and other …

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States with the Most ‘Primarily Health-Related’ Medicare Advantage Opportunities for Home Care Agencies

With hundreds of plans reportedly offering in-home support services in 2021, the coming year is certain to bring more Medicare Advantage (MA) opportunities for home care agencies. But some home care operators will have more opportunities than others due to geographic variability across the MA landscape. To find leads, agency leaders will need to understand …

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Number of MA Plans Offering In-Home Support Services to Increase by 93% in 2021

The U.S. Centers for Medicare & Medicaid Services (CMS) last month released new Medicare Advantage (MA) figures highlighting a massive expansion of plans offering home-focused supplemental benefits in 2021. The agency shared additional data on Wednesday — and it now appears the ongoing home care MA movement is even bigger than originally anticipated. “These benefit …

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