This article is part of the HHCN+ membership
Last week, Sue Chapman Moss, Kunu Kaushal and Bill Gammy were featured on the latest episode of HHCN+ TALKS, a live interview series of home health care news for HHCN+ subscribers.
Throughout the episode, these leaders representing Bayada Home Health Care, Senior Solutions, and Kaiser Permanente spoke to me about a variety of ways their organizations are working toward value-based care arrangements, anticipating and navigating the biggest challenges associated with these opportunities, and more.
Mr. Moss, Mr. Kaushal, and Mr. Gummy emphasized the importance of meaningful data, clinical innovation, and strong partnerships to build value-based care contracts. Some of their insights were of most interest to me. One is what kind of relationships home health care providers need to develop with payers to evolve their reimbursement strategies. Without strong connectivity, providers cannot gather the information needed to determine what payers want beyond just readmission data.
I also look to the future of home care in values-based care. This conversation made it clear that while many changes are needed to enable home health providers to become more involved in value-based care, trends are moving in the right direction. Home care providers can look forward to a clear definition of value-based care that solidifies their place in alternative payment systems.
We believe that the knowledge gained from all three panelists provides perspective on the current state of home care and value-based care and the future of these types of arrangements.
This week's members-only HHCN+ update covers this TALKS discussion and the salient themes that emerged from the conversation, including:
– How home health providers can go beyond “contract tracing”
– To truly gain value-based momentum, partner providers need to work together.
– Personal care needs to define what value-based care means to their industry
Pursuing value-based care contracts
When I asked all of the panelists about common mistakes home care providers make when trying to develop values-based care arrangements, both Moss, managing director of payer and provider contracts and strategy at Bayada, and Kaushal, CEO of Senior Solutions, pointed to certain dynamics that can sometimes form between payers and providers.
“The mistake is actually looking at the payer as a transactional relationship,” Moss told me. “Our approach is definitely a partnership mindset.”
Bayada, a home health, home care, hospice and behavioral health company, has a number of value-based agreements with payers. This includes both national and local Medicare Advantage plans, as well as many managed Medicaid side arrangements.
By emphasizing alignment, transparency, and real-time course correction, Bayada ensures that our payer partnerships are more than just transactional. The company achieves this by maintaining continuous communication with its partners.
“I think it’s really important to have a partnership mindset,” Moss said. “Ultimately, I think the underlying theme here is undervaluation and seeing it as a historical and adversarial relationship, and that's a real barrier to success. Value-based care is not a one-time deal. It's a journey, and having a continuous improvement mindset is definitely very important on that journey.”
Similarly, Kaushal noted the importance for home care providers to understand what their payment partners' primary interests are.
For example, many payers are concerned about readmissions, but providers need a more detailed understanding of where their organizations are focused.
To gain this understanding, home care providers must go beyond what Kaushal describes as simply “chasing contracts.”
“There's a deeper dimension or subpopulation that they're really focused on,” Kaushal says. “I think if you can build that relationship, that's enough to talk to them. I call it 'contract chasing,' but if you're chasing a contract just because you know it exists, they're not going to elaborate on the real intent behind it. You have to take the time to talk to them to understand.”
Based in Brentwood, Tennessee, Senior Solutions provides personal care services, transportation solutions, and nutritional support. The company has value-based contracts with managed care organizations.
Senior Solutions and Bayada are not the only home care providers prioritizing values-based care arrangements.
HarmonyCares has been vocal about its participation in the REACH program for Medicare Shared Savings Programs (MSSPs) and Accountable Care Organizations (ACOs). The company also partners with Medicare Advantage (MA) plans, which focus on frail populations with particularly high needs.
“Value-based care really ties in with patient outcomes, and it also leads to greater value creation by being able to go out and provide those services essentially in the home,” Matt Chance, CEO of Harmony Cares, previously told Home Healthcare News. “This is an area that we feel strongly about. This is an area that we continually advocate for and want to protect as a whole as a place of service.”
As home care providers' participation in value-based care becomes more common, I believe leaders will become less focused on chasing contracts and more intentional about how they approach these arrangements. The evolution of values-based care in this field will increasingly require intentionality around these partnerships.
Home care providers also need to partner with the major companies active in these payers.
“It could be the director of nursing,” Moss said. “It could be someone from quality. It could be the chief medical officer. I think it's really important to bring them to the table early on because they understand the value that you're creating. We want to reflect on the fact that we're the eyes and ears of the household.”
In my opinion, someone like Gammy, who is senior director of post-acute care at Kaiser Permanente, with a background in home care, is ideal for building such a relationship.
“Being able to participate in home health care, palliative hospice care, and integrated labor and delivery completely set the standard for me to come to Kaiser and feel like a champion in my field and have a really unique ability to see both sides of a scenario,” he told me. “It has allowed us to communicate better at different levels within this organization.”
Prior to working at Kaiser Permanente, Gammy served as Executive Director of Seasons Hospice and Palliative Care. This company would later merge with Accent Care. He also served as SVP of Advantage Home Health Services.
These roles also allowed Gammy to understand the constraints that home care providers often face.
“Having that background and experience has allowed us to navigate these waters more fluidly, more focused, and really considering both what we need to do as an integrated delivery provider and the constraints and opportunities that exist in providing home health care…We have a lot of discussions in our civilian missions as well,” he said.
Personal care value-based care framework
When we think of value-based care in relation to home care, even home primary care, it is natural to focus on home health care.
This means that non-clinical home care, or personal care, is often left out of the conversation.
A few months ago, at HHCN's FUTURE conference, Kaushal noted that there is no clear values-based definition of personal care today, but shaping one is necessary for providers to continue to progress.
“Most personal care agencies are not large enough or sophisticated enough to be ready to pilot programs that would expose them to risk,” he told me on TALKS. “For me, there's a lot of work to do.”
Personal care providers tend to be less involved in values-based care, but that doesn't mean agencies aren't carving out a space for themselves.
I think Kaushal's suggestion that personal care companies start by piloting and testing different values-based care arrangements will be crucial for home care providers as they move toward where the pack is headed.
“Once that's established and there's enough history and data and predictability or at least a strategy around it, I think there could be a risky model emerging,” he said.
Kaushal also sees the Centers for Medicare and Medicaid Services' (CMS) focus on personal care as promising for home care providers interested in value-based arrangements.
“I see light at the end of the tunnel,” he said. “I know that CMS wants to make personal care value-based in their broader plan. They at least have a framework in place for home health care and other settings where they know there can be an impact. My guess is that CMS is keeping things loose enough for the best ideas to percolate and actually rise to the top.”
Another important factor to consider is that personal care providers are generally expanding the range of services they offer.
For example, Synergy HomeCare launched a specialized care program for individuals living with cancer and partnered with a leading mental health platform.
Synergy is just one company, but you don't have to look too hard for examples of personal care providers expanding the definition of non-clinical home care.
As home health providers continue to expand their repertoire and emphasize their role in the continuum of care, I predict that this will ultimately lead to the establishment of a clear framework for these types of arrangements, better positioning the industry to provide more value-based care opportunities.
