• Skip to primary navigation
  • Skip to main content
  • Skip to footer

Net Health

Purpose-built EMR Software + Solutions for Outpatient Care

Home

Solutions

Therapy

SNF & Senior Living
Hospital Outpatient
Private Practice
Home Health
Acute Care

Wound Care

Hospital Outpatient
Private Practice
Data Solutions

Occupational Health

Employee Health for Hospitals
Employee Health for SNFs
Occupational Medicine Clinics

Hospice

Hospice Management

Telehealth

For SNF & Senior Living Therapy
For Hospital Outpatient Therapy
For Private Practice Therapy
For Home Health Therapy

For Wound Care
For Hospital Employee Health
For Occupational Medicine

Digital Marketing Services

For Therapy
For SNF & Senior Living
For Wound Care
For Occupational Medicine

Professional Services

For Therapy
For Wound Care
For Hospital Employee Health
For Occupational Medicine

Revenue Cycle Services

For Hospice
For Occupational Medicine

Resources

Net Health Resources Page, Webinar, green image
Outpatient Therapy

Grow Your Rehab Therapy Practice Using Paid Ads and Search Engine Marketing

When done right, paid advertising and search engine marketing are amazing tools to reach new patients and grow your business. By applying several basic tactics, you can start using powerful digital advertising platforms like Google and Facebook to target specific audiences and help ensure a steady flow of business for your practice. Click to View […]

Click to View Webinar
Net Health Resources Page, check mark, red image
Hospice

Five Key Stressors Hospice Professionals Face, with Guidance for Support

Hospice professionals help others face death and loss, while juggling interdisciplinary communications, quality compliance regulations and ever-evolving technologies. You are continually there for families and their dear ones who are passing away. But what about you? Get the eBook In caregiving professions, it is easy to get swept up in the needs of others and forget […]

Get the eBook
Sales: 800.411.6281
Please make a solution selection below and we will be in touch with you to schedule a demo.

Blogs + Articles

Browse all blogs
SNF & Senior Living Therapy
Outpatient Therapy
Home Health Therapy
Wound Care
Employee Health
Occupational Medicine
Hospice

Resources

Resource Hub
Webinars
Videos
Case Studies
eBooks
White Papers

About

Jason JJ James, CIO, SME blog image
Leadership

Net Health’s CIO discusses diversity and how it can build a stronger organization

Diversity in the workplace is an on-going issue but it’s an issue with solutions. To build diversity, it takes forward-thinking initiatives, a reexamination of the hiring philosophy, and the support of the company’s decision-makers.  One such supporter of diversity in the workplace is Net Health’s CIO, Jason “JJ” James.  Recent social movements like Black Lives […]

Read More
Net Health's Fireside Chat on Race blog image
Our Culture

Tough Questions | Real Answers: Net Health’s Fireside Chat about Race

Net Health did something different recently. Nearly two hundred employees and their families gathered around their computer screens to take part in a landmark event in our company’s history – we called it a “Fireside Chat about Race”.  The purpose of this event was to have a truly open conversation about the controversial but relevant […]

Read More

About Net Health

Company
Leadership
Partners
Careers
Press Releases

Contact

Login

Agility

844.464.9348

CliniSign

772.403.1301

Hospice

855.417.1420

Net Health U

Optima Therapy

772.403.1301

Net Health Therapy
(formerly ReDoc)

844.464.9348

Net Health Wound Care
 (formerly WoundExpert)

844.464.9348

Schedule a Demo
Uncategorized What’s the Advantage in Medicare Advantage?

What’s the Advantage in Medicare Advantage?

May 8, 2018 by Net Health

Older adults have a few insurance options for healthcare, one of which is Medicare Advantage (MA). MA plans provide coverage for traditional Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and often provide additional benefits, such as prescription drugs, vision and dental care. The main difference is that MA plans are offered through private insurance companies and are paid a fixed amount each month to cover a patient’s benefits, instead of through the traditional Medicare fee-for-service (FFS) model.

MA market share has grown in recent years, due in large part to the aging of baby boomers and policies put in place since the Affordable Care Act passed in 2010. Today 33% of Medicare patients choose Medicare Advantage over traditional Medicare, and that number is on the rise. Projections from L.E.K. Consulting’s Healthcare Service indicate that MA enrollment could reach as much as 60% and 70% of the Medicare population between 2030 and 2040.

Why is Medicare Advantage becoming more popular?

According to a study published in Health Affairs, MA plans have been successful because they are spending less and achieving better health outcomes when compared to traditional Medicare. Some of the benefits cited include fewer acute and post-acute care episodes and lower hospital readmissions. According to analysis from Brookings, a nonprofit public policy organization, the study was significant because it showed these benefits were achieved through closer management and coordination of post-acute care—rather than, as some have argued, because MA plans enroll only healthy seniors.

However, there is significant concern within the post-acute care (PAC) community that quality of care may suffer under Medicare Advantage, and that patients may have fewer provider choices. A 2017 report from the Government Accountability Office seems to support these concerns. After examining 126 MA contracts with higher disenrollment rates, GAO found that MA enrollees in poor health were substantially more likely (on average, 47% more likely) to drop out of MA plans because they had trouble accessing the care they needed.

Impact on post-acute care

The fact remains that the MA market is growing, and many of the new people eligible for Medicare are choosing MA plans. What does this growth mean for post-acute care providers? MA plans use a number of strategies to manage post-acute care—how they impact PAC providers depends on the care setting. The following includes an overview of MA’s potential effects on skilled nursing and hospice.

Skilled nursing facilities  

Many in the SNF community are worried that MA plans will disadvantage seniors in need of skilled nursing. It’s a justifiable concern. One recent Brown University study found that traditional Medicare enrollees were more likely to enter higher-quality skilled nursing facilities than Medicare Advantage enrollees.

They’re also concerned about the loss of MA patients to other lower-cost settings, such as home health. While this trend will likely impact SNFs over the long term, a March report from Avalere Health, a Washington, D.C.-based consulting firm, showed that this is only happening in certain areas of the country.

In fact, far more concerning is the overall decline in SNF occupancy. The Avalere report noted that SNF utilization rates have declined by 15% since 2009. According to Fred Bentley, vice president at Avalere Health, “While hospitals that are aggressively moving to value-based payment are shifting discharges from SNFs to home health providers, the biggest driver of the decline in SNF use appears to be the reduction in hospitalizations.”

Hospitals are not only under pressure to reduce costs, they’re also being held accountable for the outcome of a patient following discharge from inpatient care. In response, they’re moving away from traditional inpatient stays in favor of observation stays.

This is significant because to qualify for SNF care, a Medicare patient must have had at least three days of care in an inpatient hospital prior to being admitted to a SNF. If the patient is admitted to the hospital for observation, rather than an inpatient stay, they will not be eligible for SNF care following discharge.

Medicare Advantage could provide some relief to SNFs feeling the effects of low occupancy. Under MA, SNFs can create an in-house insurance plan, known as an institutional special needs plan (I-SNP). This plan is designed to cover MA-eligible individuals who require or are expected to require the services provided by a long-term care facility, such as a SNF. I-SNPs can choose to waive the three-day rule for skilled nursing coverage—giving SNFs an opportunity to provide skilled nursing and manage care for patients without a qualifying hospital stay.

Hospice

Currently, hospice is not a covered benefit under Medicare Advantage. If an MA beneficiary is in need of hospice care, he/she will be covered by traditional Medicare. However, as MA plans continue to grow, there has been talk of adding hospice care.

Many in the hospice community have expressed concern that the inclusion of hospice care under Medicare Advantage would negatively impact patient care. The Hospice Action Network, a hospice advocacy organization, has argued that based on the industry’s past experience with commercial insurance and Medicaid managed plans, MA plans would limit beneficiary access to the hospice of their choice, decrease quality and increase administrative burden.

It remains to be seen whether MA plans will include hospice care. But one thing is certain—all post-acute care providers will need to be more proactive about how they deliver, track and manage patient care in the future.

Using data to stand out

Outcomes data is the key to success as Medicare Advantage continues to expand and traditional Medicare moves ever closer to value-based payments. SNFs continue to be held accountable for higher-than-expected patient readmission rates—and will need solid, verifiable data to demonstrate their performance.

PAC providers will also need data to compete for the limited number of spots in an MA plan network. According to Brookings, providers will need to convince MA plans that they have lower costs and good patient outcomes in order to win MA contracts.

MA plan providers are putting pressure on post-acute providers to hit aggressive length of stay goals while maintaining high quality outcomes. To meet these targets, PAC providers will need to have the right infrastructure in place—including EMR systems, data analytics and reporting tools that can help them demonstrate their value to MA providers and other referral sources, and more effectively manage patient populations with targeted, patient-centered care.

 For more information on how business intelligence tools can be used to drive decision making and demonstrate patient care, watch our webinar: Dealing with a Data Flood or Drought? Overcoming Issues with Data Intelligence

Related

LinkedinShareTweetMailPrint

Filed Under: Uncategorized

Subscribe and See More

  • This field is for validation purposes and should be left unchanged.

Footer

About

  • Company
  • Leadership
  • Careers
  • Locations
  • Our Culture | The Buzz
  • Press Releases

Resources

  • Resource Hub
  • Our Blog
  • Client Services

Care Settings

  • Hospital
  • Post-Acute Care
  • Private Practice

Sales

800.411.6281

Copyright © 2021 · Net Health · Sitemap · Privacy Policy