So far, health plans have been relatively quiet about their strategies for offering in-home services and support to members under expanded Medicare Advantage (MA) policies. However, they now appear to be finding their voice.
On Wednesday, Aetna Medicare publicly announced it has teamed up with CareLinx and its nationwide network of more than 300,000 tech-enabled caregivers for the first time. Operating under the broader Aetna umbrella, Aetna Medicare has been working with Burlingame, California-based CareLinx throughout 2019 in Arizona, California, Connecticut, Nevada, New Jersey, and Washington.
According to the health plan, by connecting its members to CareLinx’s pool of vetted caregivers, Aetna Medicare hopes to support older adults with a range of daily living activities, such as taking medicine, preparing meals, and tackling light housekeeping.
“Finding a qualified caregiver who can help you or your loved one can be challenging,” Christopher Ciano, head of Aetna Medicare, said in an announcement. “Resources like CareLinx will simplify the process and connect Aetna Medicare members to qualified caregivers who can join us in supporting our members’ individual needs, preferences, and overall health goals.”
Few, if any, home care companies have been more aggressive than CareLinx when it comes to hunting MA opportunities. In December, for example, the company rolled out a turnkey platform for potential MA partners looking to incorporate non-medical home care into their supplemental benefits mix. Roughly two months later, CareLinx announced it had acquired the Optimal Aging transitional care platform from Providence St. Joseph Health (PSJH), a move that also played into its MA objectives.
CareLinx CEO and President Sherwin Sheik have repeatedly hinted at his company’s MA relationships. However, he hasn’t been able to discuss them openly. “Our entire strategy and business model is about Medicare Advantage,” Sheik told Home Health Care News. “Over the past year or so, we’ve talked about how we have these collaborations. We’ve been running with some extended health plans and delivered some excellent results so far, including with Aetna.”
He said it is too early to share results publicly, also declining to comment on the number of Aetna Medicare members with access to CareLinx-related benefits. By working with CareLinx, eligible Aetna members receive a specified number of hours at no added cost. They can also receive discounted service when more hours are needed.
2021 is still ‘the big year.’
Medicare Advantage became relevant to the home care world in April 2018, when the Centers for Medicare & Medicaid Services (CMS) shockingly declared it would allow non-medical in-home care services as supplemental benefits in 2019.
Earlier this year, CMS doubled down on home care’s role in MA, encouraging plans to experiment with any benefits that “have a reasonable expectation of improving or maintaining the health or overall function of beneficiaries with chronic conditions” in 2020.
MA’s interest in working with home care providers was lukewarm in 2019. Largely due to the steps CMS has taken, that’s rapidly heating up. “We see exactly how we thought it would play out,” Sheik said. “But I still think the big year will be 2021 — not 2020.”
Aetna, in particular, is an interesting MA connection for a home care provider. The insurance giant merged with CVS Health in a $70 billion deal last November. CVS has been vocal about its ambitions to provide care tailored to older adults from its MinuteClinic locations and community-based health hubs — a goal supported by its ties to the Age-Friendly Health Systems initiative. Additionally, CVS owns Omnicare, a long-term care pharmacy provider to skilled nursing facilities (SNFs) and senior living communities.
Building transitional care programs
In a 2019 survey by The Commonwealth Fund, about 44% of participating MA beneficiaries reported having trouble with at least one daily living activity (ADL). Roughly one-third said they struggle with two or more ADLs, including regular day-to-day tasks such as getting dressed or taking a shower.
Considering such statistics, CareLinx only expects its relationship with Aetna to grow. “What we’re seeing is consistent with all the literature out there,” Sheik said. “Medicare Advantage members value having personal care support services if they need that support in the home.”
Anthem Inc. (NYSE: ANTM) was one of the first to detail its expanded 2019 MA offerings across many affiliated health plans, with a benefits package focused on nutrition, transportation, social isolation, and home safety. Meanwhile, SCAN Health Plan and CareMore, an Anthem subsidiary, has been working with Los Angeles-based 24-Hour Home Care. “More and more, we’re seeing payers embracing providing these services to their members,” Sheik said.
