The recent robust growth of Medicare Advantage plans brings challenges, opportunities, and new regulations for home health agencies. As we head into 2024, here’s a summary of the latest news, updates, and anticipated trends for Medicare Advantage.
The Rising Importance of Medicare Advantage Comes with Challenges
Medicare Advantage (MA) continued its blazing growth throughout 2023, surpassing 51 percent of total Medicare1 for the first time in December and demonstrating ongoing consumer preference for lower upfront costs. However, this trend is not without controversy: Care advocates have been raising alarms about access to care, denials, and hidden fees. These claims are backed up by new research from the American Hospital Association showing that MA denials are up 53 percent in the past year.2 New updates from CMS in 2023 highlight the government’s efforts to reign in predatory marketing practices, pre-authorization programs, and other barriers to care, but many providers are wondering if these regulatory efforts will be as effective as hoped.
CMS Updates to Medicare Advantage for 2024–2025
In March of 2023, CMS announced a rate increase of 3.32 percent for MA and updated the risk adjustment methodology to be phased in over the next three years, beginning in 2024. CMS also imposed several restrictions on how prior authorizations can be used by the plan, limiting their use for new enrollees undergoing treatment and limiting the ways in which prior authorization data can be used overall. MA plans will also be required to have a utilization committee responsible for ensuring plan policies are aligned with traditional Medicare requirements and benefits.
In November, CMS released the 2025 Policy and Technical Changes to the Medicare Advantage Program Proposed Rule, which included:
- New guardrails for plan agents and brokers to ensure fair competition among MA plans.
- Expanded access to biosimilar drugs.
- Expanded access to behavioral health services provided by marriage and family therapists and mental health counselors.
- Benefit notifications provided to plan participants.
Benefit notification is a key effort to advance plan transparency and reduce health disparities by ensuring patients know about all of the benefits available to them from their plan. CMS has expressed concern that plans may be using benefits primarily as marketing rather than encouraging their use to improve beneficiary health and wellness. The proposed rule would require the plan to notify beneficiaries of supplemental benefits they have not accessed, the details of what benefits they have remaining for the year, out-of-pocket costs, and how to access the benefits. For more information on these updates, review the factsheet and proposed rule for Medicare Advantage. Note that the deadline for comments is January 5, 2024.
Opportunities for Home Health
Seventy-seven percent of healthcare consumers value in-home care as the most important benefit for a Medicare Advantage plan to offer, according to a recent survey3 of beneficiaries. Coupled with a 13 percent increase since 20124 in the number of homebound Medicare beneficiaries, the recent moves by large MA plans to acquire home health services is unsurprising, albeit impressive in scale.
MA plans have the potential and means to remake the home health industry by pulling on the pursestrings of more and more home health agencies as their share of the market continues to increase. How can agencies survive, adapt, and grow in such an environment?
How Agencies Can Get Started with Medicare Advantage
Home health experts point to the importance of understanding what your agency has to offer, providing evidence of that value, and understanding how working with a plan will impact the operations of your agency. From a data perspective, understanding your capacity and staffing, ensuring quality (in particular reducing unplanned ED visits), and improving patient satisfaction are key to winning contracts with MA plans.
Learn more from NAHC President and CEO Bill Dombi and our panel of experts in our recorded presentation Medicare Advantage Essential Strategies for Continued Growth and Success.
References
- KFF: Medicare Advantage in 2023: Enrollment Update and Key Trends (August 2023)
- AHA: Hospital Vitals: Financial and Operational Trends
- Advisory Board Webinar: Medicare Advantage: Policy changes, competition, and complexity explained (December 5, 2023)
- Ornstein KA, Garrido MM, Bollens-Lund E, Husain M, Ferreira K, Kelley AS, Siu AL. Estimation of the Incident Homebound Population in the US Among Older Medicare Beneficiaries, 2012 to 2018. JAMA Intern Med. 2020 Jul 1;180(7):1022-1025. doi: 10.1001/jamainternmed.2020.1636. PMID: 32453343; PMCID: PMC7251502.
https://www.medbridge.com/blog/2024/01/medicare-advantage-updates-and-trends-for-2024/
