How Medicare Advantage In-Home Health Assessments Keep Seniors Healthier

Today, Medicare Advantage delivers affordable, high-quality care to more than 33 million seniors and people with disabilities, with better health outcomes than Fee-for-Service Medicare (FFS). One of the most effective ways to ensure seniors receive comprehensive care is through an in-home health assessment.  

Seniors value in-home health assessments because they empower them to take control of their health in a way that is easy and affordable. These assessments help keep seniors healthier and more independent by identifying gaps in care and collecting critical information that allows health care providers to create personalized care plans, tailor interventions, and monitor health changes over time.  

What is an In-Home Health Assessment? 

An in-home health assessment is a detailed evaluation aimed at identifying an individual’s health risks and needs. Typically conducted annually, the assessments involve a series of questions about a person’s medical history, lifestyle, and current health status. In Medicare Advantage, these assessments are a cost-effective way to identify and meet the medical and non-medical needs of beneficiaries, keeping more seniors healthy. 

The Role of In-Home Health Assessments in Keeping Seniors Healthier  

Medicare Advantage leads the way with care innovation, including preventative care and holistic health management. In-home health assessments are a key part of this approach. Here’s how they help keep seniors healthier: 

• Early Detection and Prevention
  

  One of the most significant benefits of in-home assessments is that they give providers an opportunity to detect potential health issues or risks early. These include social determinants of health and other factors that would be overlooked in a traditional doctor’s visit. For example, during an in-home health assessment, a provider might note stairs that pose a fall hazard, or a lack of available food options. In-home assessments are just one reason Medicare Advantage identifies, documents, and treats chronic conditions earlier than Medicare FFS. For example, Medicare Advantage beneficiaries with prediabetes who develop type 2 diabetes are diagnosed, on average, nearly five months earlier than similar FFS beneficiaries.  

• Personalized Care Plans
  

  In-home health assessments provide information that contributes to customized care plans. These plans address the unique health needs of individuals, ensuring seniors receive appropriate and effective treatments. Personalized care plans can include medication management, lifestyle modifications, and referrals to specialists, all designed to maximize overall health and wellbeing. This comprehensive care includes access to supplemental benefits not covered by FFS Medicare: 99% of Medicare Advantage plans offer vision coverage; 97% of plans offer dental coverage; and another 97% of plans offer hearing.   

• Improved Patient-Provider Communication
  

  In-home health assessments promote better communication between patients and health care providers by facilitating open discussions about health concerns, lifestyle choices, and treatment preferences. Enhanced communication leads to stronger patient-provider relationships, which are crucial for effective care and patient satisfaction. In fact, 95% of Medicare Advantage beneficiaries are satisfied with their health care quality. 

• Enhanced Chronic Disease Management
  

  Many seniors live with chronic conditions that require ongoing management. In-home health assessments help track the severity and progression of these conditions, allowing for more precise and proactive management. Regular assessments ensure that treatment plans are up to date, helping to manage symptoms and prevent complications. Compared to FFS Medicare, Medicare Advantage beneficiaries experience lower rates of inpatient utilization and emergency room visits for beneficiaries with certain chronic conditions including diabetes, hyperlipidemia, and hypertension.   

How In-Home Health Assessments Contribute to MA Payment Accuracy  

In-home health assessments give skilled clinicians the opportunity to assess the health status and demographic characteristics of beneficiaries. This detailed information helps Medicare Advantage plans ensure that beneficiaries’ care will be fully covered. In-home assessments contribute to MA payment accuracy by: 

• More accurately and comprehensively diagnosing seniors, making it easier to determine the anticipated costs of caring for beneficiaries, particularly those with chronic or severe conditions that may not yet have been identified.  
•  Allowing for the development of personalized health plans. Holistic care management contributes to better alignment of the actual cost of care by reducing hospitalizations and the overall cost of providing care.  

Modernizing In-Home Health Assessments 

In step with its commitment to modernizing Medicare Advantage, BMA has called on the Centers for Medicare and Medicaid (CMS) to build on the value of in-home health assessments for beneficiaries by ensuring they are administered with consistent quality and accountability. BMA’s policy recommendations include: 

• Codifying a robust set of best practices that stipulate who can perform in-home assessments, what components must be included, and processes for follow-up care. 
• Mandating annual reporting from health plans to ensure transparency and accountability for in-home health assessment best practices. 
• Assessing whether health plans act in accordance with the best practices. 
• Requiring health plans to incorporate questions related to health equity into all in-home assessments. 

In-home health assessments are an important touchpoint to holistically and comprehensively assess the health and well-being of beneficiaries, and when necessary and possible, connect them to community resources, services, and providers for ongoing care and care coordination. 

How Medicare Advantage In-Home Health Assessments Keep Seniors Healthier