Health plans generally do not have great visibility into their members’ care after an acute health event. Even when they do, many aren’t confident in the post-acute care provider that’s serving their member.
These findings come from a new survey of health plans conducted by the post-acute care technology company WellSky.
Specifically, the survey found that:
– Only 37% of respondents (health plans) manage members in a post-acute setting after discharge from acute care. The majority attempt to manage care internally rather than partnering with vendors or other post-acute networks.
– Just 33% of respondents reported that “the majority” of their members are discharged to “high-performing” post-acute care facilities.
– 43% of respondents expressed “moderate confidence” that their members receive the appropriate level of care post-discharge.
The health plan respondents – which were Medicare Advantage (MA) plans – ranged from those with 115,000 members to those with over seven million members.
“These findings reinforce what we continue to hear from payers regarding how important it is for MA plans to have greater visibility and proactive influence into their members’ discharges to ensure they are being sent to not only the right level of care, but to high-performing post-acute providers for a member’s specific conditions,” Andy Eilert, president of payer and emerging markets at WellSky, said in a statement. “This will help plans achieve lower total cost, enhanced quality of care and improved member outcomes.”
This is noteworthy information for home health providers, who are trying to negotiate on higher ground with MA plans. Quality home health care can reduce the Medical Loss Ratio for health plans. If those plans don’t have much visibility into where their members are getting post-acute care – in other words, lacking solid partnerships – or are having members use subpar providers, that leaves room for opportunity.
Home health providers that can establish relationships with MA plans, where they can take a certain number of patients in a given market, can negotiate for better rates or a better payment setup than they currently have.
That, in turn, can help bridge the gap between MA’s rates for home health services and traditional Medicare’s rates.
Currently, over half of Medicare beneficiaries are under an MA plan. Last year was the first time ever that there were more MA beneficiaries than traditional Medicare beneficiaries.
“With this being a relatively unmanaged area, MA plans are now realizing the significant opportunity to improve in this area and are looking for next-generation solutions that generate better outcomes across the entire episode, including readmissions.” Eilert continued.
As home health access decreases, providers are gaining more leverage in the relationship between themselves and MA plans.
Health plans “want more home health care,” not less, CareCentrix CEO Steve Horowitz told Home Health Care News earlier this year.
Between 25% and 30% of inpatient stays are avoidable, according to WellSky data. Health plans, in this aspect, are leaving money on the table.
“There are many challenges when it comes to managing post-acute care, and we can no longer attempt to solve them in silos,” Eilert said. “We need solutions that bring care providers together in an integrated, value-based model to proactively manage these patients from acute to post-acute care to home, including avoiding readmissions back into the hospital.”
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