Operational Excellence

What Home Health Organizations Must Do To Serve Medicare Advantage Customers

05/24/2023

What We Know

Medicare Advantage (MA) Plans now manage more than half of all Medicare beneficiaries.

• Medicare beneficiaries enrolling in traditional Medicare have decreased each year since 2006.
• More than half of eligible Medicare beneficiaries are enrolled in MA Plans.
• MA beneficiaries reported 98% satisfaction with their benefit package (2020).
• Medicare saves approximately $1640 on average for every beneficiary enrolled in a Medicare Advantage plan.

Is your home health organization prepared to serve the growing number of people opting for MA plans?

Home Health and Medicare Advantage Incentives are similar.

Two significant forces drive healthcare today: The Quadruple Aim and Value-Based Care. Both have a significant effect on how home health care is provided, and how Medicare Advantage (MA) Plans reimburse health care providers, including home health. While application of the incentives may be different, both are rewarded for improving health, reducing the cost of care, enhancing the patient experience, and ensuring clinician satisfaction.

How Can Your Agency Position Itself as a Medicare Advantage Provider of Choice?

Use these four strategies when negotiating with a Medicare Advantage Plan.

1. Understand, isolate, and track the quality and patient experience measures that will provide a clear picture of the value you bring to payers.
2. How much have your organization’s functional scores improved? What are your re-hospitalization rates? Are you initiating care in a timely manner? What are your patient satisfaction scores?
3. Know your gross profit by discipline. For your organization’s current payers, know your gross profit by discipline and by payer.
4. Highlight agency and staff accomplishments. What’s your turnover rate? How do you differentiate your clinical expertise, e.g. what certifications do you hold? What is your Care Compare Star rating?
5. Establish relationships with decision makers. Create and prioritize lists of the people and organizations you will communicate with, when and how. Create quarterly communication goal reports and measure progress. Invite decision-makers in your network to visit your agency.

Writing your Value Proposition

Once your focus is clear, begin to identify your value proposition.

• Identify the values that correspond to the MA Plan drivers.
• Highlight your organization’s value using concrete examples.
• Connect your shared values – improving health, reducing the cost of care, and enhancing patient experience.
• Differentiate yourself as the preferred provider of this value.
• Finally, polish your value proposition to make it unique.
• Is there a specific customer service offering you provide that others don't?
• Do you offer any additional services related to the shared values?

Need assistance identifying, managing, and promoting strategies to serve Medicare Advantage customers? Our seasoned consultants are prepared to support your efforts. Contact Maryanna Arsenault at MA@corcoranconsultants.com to explore how Corcoran Consulting Group can help.