Why home health providers need to “mature” before they are paid fairly

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Home care leaders are gaining momentum. They are at the helm of organizations that should theoretically benefit from a surge in care over the next decade.

In the past, providers have campaigned for a seat at the table in the healthcare system, but now they hold the cards to a certain extent.

This may not always be obvious, especially in discussions with Medicare Advantage (MA) plans and the Centers for Medicare & Medicaid Services (CMS).

But with the right tools and strategy, vendors have the opportunity to potentially change the course of these conversations and compete at a much higher level.

“I think we would all like to see this industry mature and take advantage of the benefits we are creating for the U.S. healthcare system and Medicare Advantage payers,” Compassus CEO Michael Asselta told me Thursday on stage at Home Health Care News’ FUTURE conference in Nashville. “But we all need to mature to take advantage of this opportunity.”

What home health care providers need to do to mature, and where that maturation might lead, is the subject of this week’s exclusive HHCN+ update, available only to members.

A maturing industry

At the first panel of the FUTURE conference on Thursday, home health leaders took to the stage to shed the “woe is me” mentality that sometimes cripples the industry.

Asselta – who is relatively new to the industry, having only joined Compassus in May – recognized the gap between providers and the significant opportunities that could lie ahead for them in the near to distant future.

One of his first recommendations was to expand so-called “wraparound services” in addition to home nursing care.

“These recurring hospital visits are very expensive,” Asselta said. “The managed care departments already understand that and are willing to reimburse us. So we have to ask. We have to build and ask. We have to put things together a little differently for traditional Medicare, and that means offering reimbursable services under our umbrella. That means expansion, it means getting pretty big, and that’s kind of a theme we’ve heard as well.”

Compassus, based in Brentwood, Tennessee, provides home health care, home infusion, palliative care and hospice care. The company has about 7,000 employees and more than 270 “touchpoints” in 30 states.

Beyond wraparound services, Axxess CEO John Olajide acknowledged that providers need to collect and use data in more practical ways.

“You can’t get what you want from payers – or whoever the stakeholders are – if you don’t have data. And to have data, you need the right technology,” Olajide said, also on stage. “If there isn’t a large data set, there isn’t a lot of information to use (in these conversations).”

Founded in 2007 and based in Dallas, Axxess specializes in home healthcare technology.

Gentiva CEO David Causby gave an example.

The company’s home palliative care business can reduce a payer’s most at-risk patients, whose readmission rate is 30%, to less than 10%, Causby said.

This ability, together with the data, creates influence.

“For the industry to evolve, … I think companies need to scale,” Causby also said on stage. “You have to be sophisticated. You have to have a playbook for effective and efficient operations. You have to be innovative. You have to have data.”

Based in Atlanta, Georgia, Gentiva provides palliative care, hospice care and other home care services at approximately 600 locations in 38 states.

“You have to stop being downstream and waiting for the phone to ring,” Causby continued. “Go upstream and really show the value. There’s no doubt that this is going to be the fastest-growing sector in healthcare over the next 30 to 50 years. Those who are willing to go out there, do it right, be very solid in the way they do things and take the lead in innovation, technology and analytics – those are the people who are going to be successful in this space.”

Home care providers are in the right business and the right environment. But that alone is not enough.

Providers across the spectrum of home care must take the next step.

“We need to continue to push for a discussion about what leverage we give payers in the managed care space,” Asselta said. “Can we collectively as an industry start to say, ‘Hey, look, if I get results X, you can hold me accountable for results Y. And I don’t know that we can change the story until we’re willing to accept rates that don’t reflect the value that we provide.'”