This article is part of the HHCN+ membership
Home care providers who aspire to value-based care arrangements have recently become disillusioned with the process of trying to find one. They have been told that value-based care is the way to go, but often find that health systems and payers are unwilling to move somewhere in the middle.
Enhave Inc. (NYSE: EHAB) CEO Barb Jacobsmeyer has mentioned this multiple times. Medicare Advantage (MA) payers typically do not have the desire or ability to contract with home health providers when forced to consider value-based arrangements.
“I feel like they understand the value proposition of home health care, but sometimes it’s hard to beat the unit cost of home health care,” she said.
Lifespark COO Matt Kinne has noticed the same pattern within certain healthcare systems. His company is committed to risk- and value-based care, but many of those health systems seem to be falling back on fee-for-service operating models.
“I'm starting to lose faith, because I just finished having breakfast and lunch with some friends in the health system, and they said, 'We're going to take[population]health out of the naming convention and double the cost of health care. service,” Kine said at the CONTINUUM conference on Wednesday.
Values-based care is difficult and comes with risks. It should be.
But home care providers believe that's where they can get paid what they're truly worth. After all, quality care at home leads to better outcomes and significant cost savings.
There is a Home Health Value-Based Purchasing (HHVBP) model, which is still within traditional Medicare. To expand their horizons, healthcare providers need partners who truly dig deep into value-based care.
That's the topic of this week's members-only HHCN+ update.
Stagnant value-based care
Minnesota-based LifeSpark provides home health care, home care, home primary care, urgent care, senior living and other services to seniors. As mentioned earlier, the company has long been committed to value- and risk-based care.
At the turn of the decade, value-based care, rather than volume-based care, was all the rage. To some extent, this is still the case. But after COVID-19 subsided, Kinne saw more health care providers and payers throw up their hands and go back to business as usual.
This is bad news for home care providers. He believes many of the problems in modern home health care, namely capacity and payment, can be solved with a value-based care model.
“I truly believe that a president system will liberate us as an industry,” Kine said. “There are too many inherent contradictions in these very narrow programs and solutions. CMMI is very well intended and we are participating in some of those models. We need to start thinking about the people we will serve in the tsunami of older adults over the next 20 years, and think about serving them in a longitudinal and completely dispassionate way.”
LifeSpark still has a lot of support. For example, the company is financially supported by the state of Minnesota's health care plan.
The company focused on seniors, who account for the top one-quarter of spending on health insurance. LifeSpark was able to reduce expenses by using a variety of home care services to care for them. We believe this goal is achievable for many other home care organizations as well.
But if they are given a chance.
“If you look at the numbers, it's clear that the top quartile spends more than 60% of the total medical loss rate,” Kine said. “So we narrowed our focus from a fully diverse population to the top quartile of people who are at increased risk, and certainly patients with typical and very complex health conditions, to bring our focus to patients with very complex health conditions. I found myself trying to really apply my resources and assets.”
For home health care providers in particular, the ability to prove value could save them. Traditional Medicare payments have been cut for the third year in a row, and MA coverage will continue until 2025, when a plan-friendly administration comes to power.
MA plans' substandard prices per visit are the limit for organizations with margins under pressure. But the termination of plan networks also hurts health care providers who need to be trusted referral partners to the health system.
“There's a lot of inertia pushing against us,” Kine said.
reason for hope
Mr. Kine spoke on the CONTINUUM panel along with Denise Keefe, senior vice president of continuing care for Advocate Health, and Danny Metzger-Traber, vice president of strategic business operations for Mass General Brigham (MGB) Healthcare at Home. did.
Advocate Health and MGB appear to disagree with the worrying trends noted by Kinne.
“I think we're moving in that direction,” Metzger Traiber said on CONTINUUM. “What I'd like to see us go toward is having more head connective tissue that allows for alignment of incentives. If you have these aligned incentives and you're rowing in the same direction; Everything is much more facilitated.”
MGB Healthcare at Home offers a variety of home care initiatives, including home health care and home hospital programs.
The system is actively looking to care for more people at home. Capacity is an issue and there aren't many opportunities to expand through brick-and-mortar means. Therefore, expansion must be achieved through home-based services.
“We're thinking about patient populations that are a real bottleneck for us, and how we can be more creative about the routes those people get home to free up that capacity.” “I'm thinking about it,” Metzger Traiber said.
Both Keefe and Metzger-Traver emphasized that their health care system is based on a “family first” philosophy. Kine said it “gave him hope.”
“I think home care is taking center stage right now,” Keefe said. “And we're thinking about the opportunity to actually use that to help the health system in a different way.”
Ultimately, there are health plans that believe in value-based home care. I've written in the past that these plans benefit from treating your home care partner well.
The same goes for health systems like MGB and Advocate Health.
At the end of the day, providers end up getting frustrated with the process of finding the right partner. But if you look closely, the right partner does exist.
“Over the past five years, the MGB has definitely been committed to Homeland First,” Metzger Traiber said. “Our CEO said, “Whenever we evaluate these service lines, when we look at how they provide care to patients, we always want to take a view of what can be done in the home. ' is the first step.
