The pandemic has increased the demand for all things delivered at home. Meals, liquor, mattresses, and more—are all now at people’s literal doorsteps. This is true in the health and human service field too. Telehealth has brought “visits” home. Humana and Blues are sending screening kits to their Medicare members’ homes (see Humana Providing Medicare Advantage Members With At-Home Screening Tests For Colon Cancer & Diabetes Management and Blue Cross & Blue Shield Of Minnesota Provides Home Preventive Screening Kits For Medicare Advantage Members). There are new services for in-home primary care (see Heal Launches New ‘Health Assurance’ Offering) and in-home hospital services (see Mayo Clinic Teams With Medically Home To Launch National Hospital-At-Home Model).
Part of this is by mandate—non-emergency health care services have been halted in many states. But it is also a reminder that consumer confidence is just not there—consumers are afraid to get services in places where they will be in contact with the general public and exposed to the virus. This is especially true for consumer perceptions of nursing homes and other congregate care settings. The death rates in nursing homes have exceeded almost every other congregate setting (see Building The Long-Term Care System Of The Future: Will The COVID-19 Nursing Home Tragedies Lead To Real Reform? and Nursing Home Problems Are Problems For The Entire System)—and consumers are looking for alternatives.
A couple states have already responded. Rhode Island announced that it is changing the long-term care system to create more home-based care options. The state plans to invest $25 million for nursing facility supports to expand home-base care options (see Rhode Island Unveils A $25 Million Plan To Expand Home-Based Care Options). California is expanding a Medicaid program that allows low-income elderly and disabled people eligible for care in a nursing facility to stay in their own homes instead. By 2021, the Department of Health Care Services (DHCS) plans to expand the Home and Community-Based Alternatives (HCBA) waiver program from just under 4,000 slots to almost 9,000 slots (see California Expanding Enrollment In Home & Community-Based Alternatives Program). Currently, 4,688 people are enrolled in the HCBA program, and 836 are on a waiting list. The program covers skilled nursing care, home health aides, personal care services, and case management. DHCS is contracting with nine regional community-based organizations to provide the services (see Home & Community-Based Alternatives Waiver).
And importantly for planning, these pandemic-induced moves to provide home-based alternatives to nursing homes are completely consistent with policy changes by many state Medicaid plans to move their long-term services and supports programs (LTSS) to some type of managed care system. Our recent national analyses of Medicaid managed long-term services and supports (MLTSS) programs—National Trends In Medicaid Managed Long-Term Services & Supports Programs and State-By-State Medicaid Managed Long-Term Services & Supports Contracting—found 2.8 million consumers are currently covered in those programs, more than doubling (178% increase) since 2010. There are now almost half of state Medicaid plans (24 states) operating some type of MLTSS programs. Four states—Massachusetts, North Carolina, New York, and Texas—are considering expanding MLTSS services to new populations or establishing a more comprehensive model. Three states—Nebraska, Nevada, and Oklahoma—are in the process of adopting a new MLTSS program. Currently, most states select health plans to deliver LTSS services through a competitive bid process.
The strategy question for specialty provider organizations is whether the opportunity posed by this shift in policy and consumer preference presents an opportunity for new service lines and for new relationships with health plans. The U.S. population—including the population with disabilities—is aging and the demand for these support services in on the increase. And right now, about 55% of Medicaid LTSS spending is on institutional long-term care, which includes nursing homes and intermediate care facilities for people with developmental disabilities (see Who Pays for Long-Term Care in the U.S.?). Moving even a small amount of nursing home spending to home-based services presents a significant new market opportunity.
But like much of the U.S. health and human service system, which organizations can take advantage of this redirection of funding depends on your market. The key questions? Does the state Medicaid plan have an MLTSS program that will benefit from this pressure to move consumers to home-based services? Are there enough consumers enrolled in those MLTSS programs now (or in the near future) to create a market large enough to warrant an investment in a new home-based service line? What are the competitive programs providing these services? Do the MLTSS health plans have consumers with unmet needs for home-based support services? The answers to the first two questions can be found in our new deep dive into MLTSS by state—State-By-State Medicaid Managed Long-Term Services & Supports Contracting. For each state, the report provides a summary of the MLTSS program models, enrollment, covered services, managed care contract awards, and more.
Thinking about whether to provide—or expand—home-based services is a service line option that most specialty provider organizations should consider. This could take the shape of home-based services as a replacement for nursing home care or home-based services as part of a future hybrid behavioral health service line (see Blended Virtual & Onsite Services For Continuity Of Care and Telehealth – What Will The Payers Change Post-COVID-19? Let’s Ask Them). For more on considering these service line options as part of a crisis recovery strategy, check out these resources in our OPEN MINDS Industry Library:
- How To Develop A New Service Line: An OPEN MINDS Seminar On Building A Diversification Strategy & Conducting A Feasibility Analysis
- Managing Your Service Portfolio Is Key To Crisis Recovery
- Shaping A Recovery Strategy—The OPEN MINDS Strategic Planning Model
- Fire Up Your Hybrid For The Recovery Race
- ‘Leaning In’ To Medicare: Social Needs Opportunities
- Driving Better Outcomes With A ‘Whole Life’ Approach
- Necessity Is The Mother Of Invention: Innovation In A Crisis
- Demographics As An I/DD Market Opportunity
- The Changing Face Of Medicaid MLTSS For The I/DD Population
- The Medicaid MLTSS Market Shift
And to learn more on adjusting to a changing market, join OPEN MINDS Senior Associate Paul Duck on August 13 at 1:00 pm EDT for the executive web forum, Planning For Revenue Expansion By Expanding Your Service Area – From Market Analysis To Launch.