Wednesday, September 07 | Thought Leadership, Post-Acute Care, Value-based Care

Succeeding Under Medicare Advantage: What Home Health Agencies Need to Know

By Mike Dordick, SVP, Post-Acute Strategy and President of McBee

According to the Centers for Medicare and Medicaid Services (CMS), more than 64 million people are enrolled in Medicare. The fastest-growing segment of the government’s national health insurance program is Medicare Advantage (MA).

It makes up more than 42% of the total Medicare population. That number is expected to increase to 50% in the next two years and 70% by the year 2040.

Despite that growth, home health agencies are seeing lower payments from MA plans. CMS has also proposed a 4.2% cut in home health services for 2023, forcing agencies to decide if they should accept or reject MA contracts.

Tim Rowan, editor of “Healthcare at Home: The Rowan Report,” joined a Netsmart CareThreads podcast. He says, over several interviews with agencies, he’s heard the same thing: “we cannot continue to do business the way we have been.” He adds that there “has to be a complete re-thinking of ‘what exactly is the process that produces better patient outcomes.’”

Dawn Iddings (SVP of Post-Acute, Netsmart), and Mike Dordick (President, McBee and SVP Post-Acute Strategy of Netsmart) joined Rowan on the podcast.

They discuss the opportunity home health agencies face right now because of the COVID-19 pandemic. They say it highlighted the value of home-based care, and that demand for it since 2020 has only grown.

They admit there will be some challenges for these agencies, including staffing shortages, inflation and increased expenses related to COVID-19. Dordick adds, though, that the challenge may not lie with just the agencies. He thinks the proposed cut by CMS could lead to agencies filing lawsuits against CMS.

They also discuss strategies agencies can employ to succeed in today’s environment. Those include: