The rise of Medicare Advantage (MA) has reshaped the home-based care landscape, but it’s putting home health providers in precarious positions while increasingly failing to deliver for beneficiaries.. That’s according to the leader of Lewiston, Maine-based nonprofit provider Andwell Health Partners, which has significantly changed the way it cares for patients, including adjusting care plans, […] The post Andwell Health Partners CEO: Medicare Advantage Becoming ‘Failed Policy,’ Jeopardizes Home Health Access appeared first on Home Health Care News.
The rise of Medicare Advantage (MA) has reshaped the home-based care landscape, but it’s putting home health providers in precarious positions while increasingly failing to deliver for beneficiaries..
That’s according to the leader of Lewiston, Maine-based nonprofit provider Andwell Health Partners, which has significantly changed the way it cares for patients, including adjusting care plans, to adjust to increased penetration of MA. Andwell Health Partners’ CEO Ken Albert said MA is rapidly becoming a “failed policy,” on a recent episode of Home Health Care News’ Disrupt podcast.
Formerly known as Androscoggin Home Healthcare + Hospice, Andwell Health Partners offers home health care, palliative care, hospice services and a slew of other services across Maine.
Albert sat down with HHCN to discuss how the nonprofit will survive industry headwinds, the new service lines and innovations he has plotted for the organization, the future of Medicare Advantage and how nonprofit providers have to innovate to survive.
Below are selections from that conversation, edited for length and clarity.
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HHCN: I know you have a two-year plan for Andwell. Can you talk me through your priorities and where you hope to be in two years?
Albert: Ultimately, from a priority perspective, it really is about the sustainability of a nonprofit mission. As we look at hospice being above 80% for-profit nationwide, home health being above 70%, you have to ask yourself, where is there space for the non-profit in post-acute health care delivery? Really, the ultimate priority for us is ensuring that our quality, our workforce and our reimbursement are able to sustain a nonprofit mission in a rural part of America.
We’re in a time of significant change in health care, born out of necessity, and the cost of health care today on our government and other payers is significant. So we have to look at, how do we think differently and in a more innovative way with our acute care partners in primary care and specialty care and our colleagues in the long-term care industry? How do we look differently at delivering necessary services?
Again, I’ll focus on rural America. I think it is different in urban and rural areas. I don’t think that we’re going to be able to stand in our silos any longer, and we’re going to have to come out and look at what true partnerships in health care delivery across that continuum really means. So for a company like Andwell Health Partners, the focus is where is our value proposition to the health care delivery system in Maine? Where is our historical skill set, and how do we leverage that? Where do we build and grow new skill sets in order to meet the demands of our populations that we’re serving?
Looking at the industry broadly, the rise of Medicare Advantage has been an issue, to put it lightly. How does it impact nonprofit organizations like Andwell?
I understand the allure of Medicare Advantage, and I understand, from a policy perspective, the ultimate intention of Medicare Advantage, but I’m willing to go out on a limb and say that I think Medicare Advantage is rapidly becoming a failed policy in America.
It’s attractive to a consumer because of the cost and because of the shiny opportunities and shiny things that Medicare Advantage can offer that traditional Medicare has not historically offered its beneficiaries. When I say failed policy, when you have a reimbursement structure that is not continually evaluating the impact on the health care delivery system itself … where you have Medicare Advantage with quarterly profits that are significant, and parts of the health care continuum, from a provider perspective, that are unable to make the math work, unable to make the ends meet, and you’re seeing an erosion of rural access to hospital care [and] primary care, and certainly home health and other community based services, you have to ask yourself whether or not that Medicare Advantage policy is actually effective.
I would argue that when you have closures and when critical access hospitals are declining in America, that the policy is not working. You have a beneficiary here, a consumer, that has an attractive product, and as long as we had a certain Medicare margin or other third party payer margin to offset the losses in Medicare Advantage, the consumer isn’t really impacted by their choice to engage with a different program, like a Medicare Advantage product, as opposed to traditional Medicare.
However … I think rural areas of our country are canaries in the coal mine. When you see hospitals and providers and significant shortages of physicians and advanced practice nurse practitioners and so forth, the consumer will ultimately be impacted because of access. We are approaching, in many areas of our country, crisis situations with regard to access. Here in Maine, for example, it’s three months, four months, six months, to be able to get into primary care. Access to home care is very challenging because of the reimbursement. In short order, we’re going to see, I think, a shift in the consumer perspective of Medicare Advantage, when … the providers are not there to deliver the care that the Medicare Advantage product advertises.
What changes do you have to make to your organization to be able to operate in this environment?
We’ve made significant changes. Maine has been in the top five in the nation now for a few years with regard to Medicare Advantage penetration. We’re about 67% to 70% Medicare Advantage penetration. Now I think back to when we were at 50% and I’ll take those days again anytime, actually.
Historically, in home health, let’s say, we had a delivery model that was built around Medicare conditions of payment and Medicare conditions of participation. With the proliferation of Medicare Advantage plans there are any number of Medicare Advantage rules, contractual obligations that are different from one another, and certainly different from traditional Medicare. So we’ve had to design health care delivery models based on the type of reimbursement. So, a home health patient is no longer just a home health patient. You have to look at what’s the payer source, what do we know the reimbursement is going to be for that, and adjust our delivery accordingly.
We have conversations with patients who have been accustomed historically to getting physical therapy and nursing two or three days a week, but you’re now on a Medicare Advantage plan. Your plan may authorize us to be in there to deliver all the services you’re requesting, but they’re only going to pay for a portion of that. Authorization and payment are two very different things.
Medicare Advantage is a highly transactional product. In other words, you have to be cognitively, physically and emotionally able to embrace the benefits that are contained within your MA product. When your disease burden gets to the point where it is impacting physical, emotional and cognitive abilities, the benefits of Medicare Advantage begin to go away because you can’t participate in those benefits. Even from a consumer standpoint, we’ve had to adjust our approach to care delivery in order to be able to meet the nature of the individual as they relate to their insurance product.
Andwell Health Partners offers a variety of services, home health, behavioral health, hospice palliative care, mobile wound care, that list goes on. Do you plan to expand that list further?
We have our sights set on the next couple of years on some new service lines. I like to put those in the category of innovation-type services. A perfect example: two years ago, we launched mobile rehab, which was mobile physical therapy, occupational therapy. We innovated around that, and got some funding for that, and it’s just not delivering on a reimbursement perspective the way that the innovation forecast had projected. So we’re winding that type of service down.
There will always be those types of innovative services that emerge, that we will always want to play with, and which really all depend on what the communities we serve need.
It’s just not here’s a new shiny thing that’s coming along, let’s jump on that bandwagon and do it. It is evaluating whether it’s going to be a traditional service line or something that comes out of innovation. You have to evaluate whether or not we have the skill set for it. Whether or not the community needs it. What do our partners in health care delivery in the community believe Andwell Health Partners’ role would be, or might be, in the delivery of a particular service line? So it’s really market readiness. Can we scale it, and do we have the skill set and resources necessary to deliver on any particular service?
We have the main center for palliative medicine under Andwell Medical Partners, which is our medical group, our medical practices. The Maine Center for Palliative Medicine is where we do our inpatient and outpatient and clinic-based and home-based palliative medicine. We do some research out of the Maine Center for Palliative Medicine, we run a fellowship, a nurse practitioner fellowship training model.
We’re launching the Maine Center for Aging Health, that is where we will put programs like GUIDE, which we’re launching on July 1. We just received a feasibility grant to explore primary care at home, and really exploring the feasibility in our geographic area, what that might look like. We know that traditional primary care at home relying on Part B reimbursement is not sustainable, given the costs associated with primary care at home. But can we explore what collaboration and partnership with ACOs means around primary care at home? Can we look at other models of reimbursement with payers where primary care in homes makes sense?
In Maine, if you talk to long-term care and assisted living and memory care providers, geriatric psychiatry is really a service that is lacking, not only here in Maine, but all across the country. We’re also exploring how we may be able to fill that void. Do we have the resources, and are we the right organization to be doing it? It’s a need, and so we’re exploring that with our partners in the community to see whether you know who might be the most appropriate to deliver that. We know it needs to be delivered. It’s just a matter of who and how we can get there.
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