This article is part of the HHCN+ membership
Against the backdrop of payment pressure, home care leaders must find ways to operate more efficiently while meeting growing demand while increasing access and improving outcomes. Top executives have a variety of approaches to managing their operations and subtracting issues.
For Jennifer Webster, CEO of DispatchHealth, results showing results are the best thing when building a value-based refund agreement. For Jason Growe, CEO of Livewell Partners, being a referrer's “first choice” is essential to ensuring that the organization stays in the referrer mix. For others, renegotiating Medicare Advantage (MA) rates and expanding service lines are key to management in the current operating environment.
Below I think we capture some of the four quotes that capture some of the best top trends, challenges and opportunities for executives of Home Health News Capital+ Strategic Events, as well as some of the analyses that unleash these statements.
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“We are trying to negotiate with a Medicare Advantage plan so that we can accommodate as many patients as possible. As everyone in this room knows, many MA plans should not pay a fee that covers the cost directly on each visit.
– David Lester, CEO, ProHealth Home Health & Hospice
The MA market expanded to 2024 to reach 54% of the eligible Medicare population. Although MA penetration has grown, fees continue to cut the ground, and home health providers are often forced to subsidize treatment for MA patients with traditional Medicare patients margins.
Furthermore, the study shows lower home healthcare use among MA beneficiaries compared to traditional Medicare enrollment.
ProHealth is in a good company, struggling with MA rates, trying to negotiate alternative arrangements, and sometimes asking to step away from the plan. The company also faces problems that are not surprising for companies without the country's vast footprint.
Based in Birmingham, Alabama, ProHealth is a home hygiene, hospice and skilled nursing facility operator with an average of approximately 1,200 patients per month.
All these factors contribute to an environment where providers are likely to innovate, as Leicester has proposed, such as the new payment model, as Leicester did.
Other providers are moving away from the MA plan due to low rates that last without pay raises or other issues, such as pre-approval conditions. Knowing when to leave the plan is a key strategic consideration that LTM Group CEO David Kerns considers the “zero-in” process rather than leaving.
“You don't have to be everything for everyone,” Kerns previously told HHCN. “In many cases, focusing on everything is hard to focus on anything. Many providers think I have to contract with everyone and do everything. That's not always true. Instead, focus on your best payer partnership and do something really epic with them.”
Some providers who are away from the MA plan can return to the negotiation table and later create more sustainable agreements. However, others like ProHealth may have a hard time hitting positive deals due to their low leverage.
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“We must be able to demonstrate this to those who pay for that care every day through their value-based arrangements or through evidence that “look, this patient's initial tendency is to avoid going to the emergency room.” system. ''
– Jennifer Webster, CEO, DispatchHealth
As operators face pressure from MAs, labor shortages and regulatory challenges are of paramount importance to have a set of evidence to demonstrate the value of an organization's in-home service.
Payers and the healthcare system need to see the “undeniable” ROI, Webster said. For DispatchHealth, this includes a high NET promoter score (NPS) and persuasive testimony.
Based in Denver, Colorado, DispatchHealth provides home health care to people with severe health problems and treats more than 1.2 million people in more than 20 US states. In March, the company announced a medical merger with the home, closing it last week.
The average patient at DispatchHealth is 74 years old and has eight comorbidities, with 50% of these patients having been hospitalized or in the emergency room in the past six months. According to Webster, for these high-cost, high-multiple patients, home therapy saves money, helps patients feel more comfortable and allows providers to address social determinants of health.
However, providing these benefits to your healthcare system or payer partner is not enough. Care providers should be able to demonstrate meaningful savings associated with providing care at home in order to negotiate better fees and build new reimbursement agreements.
Identifying health planning issues and demonstrating that providers can address these issues is a key factor in negotiating higher rates, according to Brent Nash, Chief Development Officer at Elara Caring.
“If you just go there and say, 'I want more money,' they'll probably just laugh at you out of the room,” Nash previously told HHCN. “You said, “I want to help you. What is the point of your pain? Are you worried about readmission or Ed's repurposement?”
Home care companies invested in robust data collection systems have discovered significant cost savings that can be used in negotiation tables. For example, BrightStar Care launched a new data system and conducted analysis of the personal care business. The company reported an average savings of $13,000 per person over 30 different conditions, and an average savings of $30,000 for heart failure patients.
Telling a compelling story through data to health systems and payer partners is more important than ever in a tough operational and negotiation environment, and can lead to new value-based refund arrangements.
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“We decided that there was some meaningful differentiation needed for the institutions because of their growth and size, so we chose to care for Alzheimer's, dementia and Parkinson.
– Ralphton, CEO, Heart, Body & Mind Home Care
Home-based care providers are looking to diversify their lines, differentiate their businesses, and create specialized services to attract clients. Choosing which conditions to specialize in requires strategic consideration.
For example, in the case of mind, body and mind home care, determining which service lines are suitable for your business model should consider the company's “ideal client profile” that includes at least nine months of care. Loughton decided to specialize in caring for Alzheimer's, dementia and Parkinson. This is because people with these conditions usually suffer from the illness for 15-20 years, need some home care after about 4-7 years, and ultimately require long or full-time home care. These patients provide stability in the patient census for heart, body and mind home care, and help to buy longer times over time, Loughton said.
Based in Fort Myers, Florida, Heart, Body & Mind Home Care offers personal care, companion care and discharge services throughout Florida.
The provider offers some level of care outside of an ideal profile, including hospice support. This helps support the amount of patients, Loughton said.
Still, heart, body and mind care avoid moving away from the ideal client to specialization. Cosmetic surgery is common in southwestern Florida, with some institutions having a large number of patients recovering from these procedures. Heart, body and mind home care are short-term clients and avoid treating these patients with co-alternative patients.
Other providers will also consider carefully when launching new service lines. VNS Health has created a product development team and released analytical tools as part of a “very calculated” approach to product launches.
As providers face tightening margins and installing competition, developing new service lines becomes essential, and choosing the right service line can make all the difference.
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“Many of our hospital systems have their own in-home health and hospice providers. We respect that. It's okay, but there's also the perception that we can't meet all the demands coming out of the facility. For a long time, we've said we want to be your first choice. Consistently, a consistently wonderful patient experience for those people will unlock the door over time.”
– Jason Growe, CEO, Livewell Partners
Building strong referral relationships is important for home health providers looking to scale. For Growe, being the best home health and hospice provider for your health system can mean playing long games.
Based in St. Louis, Livewell Partners is a home hygiene and hospice provider operating in St. Louis, Kansas City, Wichita, Kansas, Detroit and Cincinnati.
Playing a long game means being a partner with the healthcare system that offers your own home hygiene and hospice programs, knowing that patient demand is likely to exceed your abilities. That's where home health providers can intervene.
Although the demand for home health services is growing, research has shown that healthcare workers acceptance rates are only 34.5%, creating a bottleneck for patients in the healthcare system.
According to Tim Ashe, Wellsky's chief clinical officer, home healthcare providers want to recruit more patients, but several factors limit the number of referrals that providers can accept.
“The 34.5% acceptance rate actually indicates which home healthcare providers want these referrals, but in many cases it is constrained by either supply, availability, general capacity or the ability to assume a particular payer,” Ash told HHCN.
To become the “first second choice” of referrers, providers need to provide quality care quickly. This includes deploying the right level of clinicians at the right time, Growe said.
While maintaining quality is important, cost management is important to keeping operations going, Growe said. Cost reductions include leveraging Paraprofessionals where possible and managing supply costs. Keeping costs down is how the industry survives in the short term.
