Mental and physical health are vital components of overall wellbeing and can influence each other in many ways. Yet, individuals with mental health conditions may encounter challenges in accessing adequate health care, which can impede their ability to manage their physical health. Home health care providers, however, are increasingly stepping in to bridge this gap.

In-home behavioral health care provides specialized support to promote mental wellness for individuals with a wide range of behavioral or psychiatric disorders. Those who qualify may be experiencing depression, anxiety, agoraphobia, difficulties associated with aging in place, struggles with substance use or problems coping with trauma. Mental health at-home support aims to improve these patients’ access to quality care.

“Untreated mental illness or behavioral health issues can significantly increase the risk of worsening mental conditions, the progression of chronic medical conditions, and the development of heart disease, stroke, dementia and a weakened immune response,” Barbara Andazola, vice president of clinical practice, strategy and programs at Amedisys (Nasdaq: AMED), told Home Health Care News.

Amedisys, headquartered in Baton Rouge, Louisiana, provides home health care, hospice, palliative and high-acuity care in 38 states.

“Most adult patients receiving home health services have a chronic or life-altering illness that can affect their mental wellness, which is crucial for how they think, feel, cope, make health-related decisions and determine how they will participate in their care,” Andazola continued. “Providing person-centered care and achieving quality clinical outcomes is impossible without addressing patients’ mental wellness needs, especially in home health, where clinicians directly observe the impact of mental and physical health on a patient.”

Many home health providers see behavioral health as a natural extension of their mission to help seniors successfully age in place.

At the same time, as value-based care measures become more prominent, making sure seniors are as mentally fit as possible also becomes more important from a business perspective.

“Behavioral health care is a crucial offering for home health providers because it allows for continuity of care across lifespan and settings, especially for individuals with dual diagnoses or developmental disabilities,” Dallas Star, regional director for Bayada Home Health Care, told HHCN. “Home health providers can leverage their expertise in home-based care to deliver specialized behavioral health therapies such as applied behavioral analysis (ABA) in the comfort of the client’s home. This personalized approach can help clients generalize skills and improve the overall quality of life.”

Bayada provides home health, home care and hospice services in 23 states, as well as in Canada, Germany, India, Ireland, New Zealand, South Korea and the U.K.

Psychiatric registered nurses (RNs) usually provide services for this patient population, sometimes with the aid of a licensed clinical social worker.

Those with Medicaid or a limited income may qualify for in-home behavioral health care at no cost. Most providers will work with clients to seek approval and evaluate needs to determine coverage available through insurance providers.

To initiate services, clients must speak with their physician or mental health professional who can provide a referral and work with the home health care provider to develop a personalized care plan. The duration of care depends on individual needs and goals.

Psychiatric nurses conduct an initial assessment and collaborate with the physician to develop an individualized care plan. The nursing services outlined in the care plan typically include evaluating, teaching and administering medications; managing situational crises; conducting self-harm assessments; teaching self-care and promoting mental and physical wellbeing; providing supportive counseling and delivering psychotherapeutic interventions such as education on disease processes, symptom management, safety, coping skills and problem-solving.

If a patient needs additional services or a different level of care, home health clinicians, with the approval of the patient’s physician, will coordinate with local community resources to ensure the patient receives the necessary services to remain safely at home. If this is not feasible, they will arrange to transfer care to an appropriate outpatient or inpatient facility.

“Similar to patients receiving other types of in-home services, those receiving behavioral health care are satisfied with their outcomes and appreciate the ability to receive care in the comfort and safety of their own homes,” Andazola said.

States mobilize crisis intervention teams to further address access to care

The Centers for Medicare & Medicaid Services (CMS) recently approved New Hampshire’s Medicaid State Plan Amendment for community-based mobile crisis intervention teams to provide services for people experiencing a mental health or substance use disorder crisis.

New Hampshire can now connect Medicaid-eligible individuals in crisis to a behavioral health provider 24 hours a day, 365 days a year. This approval marks 20 states and the District of Columbia that have expanded access to community-based mental health and substance use services under a new Medicaid option created by the Biden-Harris American Rescue Plan.

Mobile crisis intervention teams provides screening and evaluation; stabilization and de-escalation; and coordination with and referrals to health, social and other services, as needed. This helps states better integrate behavioral health services into their Medicaid programs.

Providing fast, appropriate care to someone in crisis may reduce the need for costly inpatient services, and this new option will help states expand access to behavioral health professionals as the initial contact for someone in crisis. New Hampshire can now receive Medicaid funding for mobile crisis response crisis planning, directly connecting people to specialized services, referring ongoing supports, and follow-up check-ins for individuals experiencing a mental health or substance use disorder crisis.

Though home health providers often have behavioral health capabilities – and sometimes even specific service lines for that care – there are still barriers to implementation.

“There is a clear need for ongoing behavioral health services as a standard offering for home health patients,” Andazola said. “However, the shortage of psychiatric-trained RNs and the specific experience requirements set by Medicare for reimbursement limit the expansion of these services. The Medicare home health benefit excludes occupational therapy (OT) as a qualifying clinician discipline. Despite OTs being highly skilled and capable of addressing functional limitations often experienced by behavioral health patients due to mental illness or cognitive deficits, they can only provide these services if the patient’s condition also requires skilled nursing physical or speech therapy. Until CMS addresses these and other requirements, expanding behavioral health services for home health patients will remain limited.”

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Enhabit Inc. (NYSE: EHAB) has been active in the value-based care space. The company has a small – but growing – number of value-based contracts on the Medicare Advantage (MA) side, as well as Accountable Care Organization (ACO) partnerships.

“Typically these look like upside potential based on quality metrics that both parties agree to, and we try to pick those quality metrics that are going to lower the total cost of care of patients,” Debra Konjanovski, senior vice president of payor innovation at Enhabit, said last month during a panel discussion at Home Health Care News’ FUTURE conference. “If we perform, then we have an opportunity to have some shared savings in that.”

Dallas-based Enhabit has 256 home health locations and 112 hospice locations across 34 states.

For the past few years, payer innovation has been a major component of Enhabit’s overall strategy.

At Bayada Home Health Care, value-based care is another tool that allows the organization to deliver quality care, according to Sue Chapman Moss, managing director of payer and provider contracting and strategy at the company.

“There’s a tendency towards price suppression in our category, and so value-based care is a way to differentiate, and to be able to share the performance that we’re already creating for our patients in their homes,” Moss said during the discussion.

Bayada provides home health, home care and hospice services in 23 states, as well as in Canada, Germany, India, Ireland, New Zealand, South Korea and the U.K.

Currently, Bayada has value-based arrangement partnerships with payers, ACOs and health systems.

“We’re working with partners … that are willing to make an investment in our caregivers,” Moss said. “The contracting structure is probably the least interesting factoid of our value-based care. It’s how we’re spending the dollars, and investing in our workforce, that we’re most pleased with.”

Moss believes that not diving into value-based care would be a missed opportunity for Bayada.

“If you believe in your care model, what you’re doing in the home is creating value,” she said. “If you’re not working with your payers to secure a portion of that value, and you’re just taking fee-for-service rates, all of that value is dropping 100% to the bottom line of the payer, or the risk bearing provider. We view it as part and parcel to securing better value and being able to hire caregivers and invest in great training.”

Key metrics and navigating challenges

Though it varies depending on the payer, there are some key metrics that home-based care providers should be ready to present when trying to establish value-based care arrangements.

“If you’ve met one payer, you’ve met one payer,” Integrated Home Care Services CEO Chris Bradbury said during the discussion. “Even within the payer, depending upon the line of business, whether it’s [MA], managed Medicaid or the commercial line, the ranking of the priorities differ. [However], there are some things that cut across all of them. Timely access to quality of care is super important, no matter who you’re talking to within the payer, whether it’s the network folks, the clinical folks, the finance folks or the line of business leaders for [MA], manage Medicaid or commercial.”

Integrated Home Care Services is a driver of value-based care in the home. The company partners with health plans, providers and other risk-bearing provider organizations.

Bradbury noted that providers should also be prepared to present patient experience metrics.

“With the changes in star ratings, I know our health plan clients that participate in [MA] are far more attuned to the patient experience, and how what you do can either positively or negatively impact their brand,” he said. “It can have a material impact on their financials and their growth.”

Konjanovski pointed out that providers sometimes face the challenge of finding the right person to talk to within the organization that it is trying to establish a value-based arrangement with.

“At times, it’s hard to find the right person in the organization that you need to talk to that can actually make the decision, and then once the decision is done and it’s on paper, actually executing it is a very long process,” she said.

It’s important for providers to recognize when an organization isn’t ready to fully commit to entering a value-based arrangement, according to Moss.

“Not all payers are ready,” she said. “If they’re struggling to pay claims and focused on audits and utilization management, that does not signal an organization that’s ready for your team to invest a lot of time and energy into a value-based arrangement.”

Ultimately, it’s best for providers to enter arrangements with organizations that want to establish a long-term partnership.

“[Find] payers who are willing to make a multi-year commitment,” Moss said. “These are not easy, one-year deals, and so you need to find partners that are willing to put in the time and the energy. Value-based arrangements take some time to get right and to learn together. If you have an adversarial negotiation, sometimes that doesn’t necessarily lend itself to a collaborative relationship at the end, so you always need to keep that in mind as you’re going through the process.”

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Organizational culture refers to the shared beliefs, values, attitudes, behaviors and practices that define an organization. It includes unwritten rules, norms and social patterns that influence the behavior and interactions of individuals within the organization.

When employees feel a sense of belonging, they are five times more likely to stay with the same company for an extended period, three times more likely to generate revenue faster than less inclusive competitors and nine times more likely to believe that people are treated fairly, according to data from Great Place to Work.

“There has been a positive correlation with retention rates since we’ve doubled down on recognition, culture and employee experience,” Jeff Knapp, chief people officer at Bayada, told Home Health Care News.

Bayada provides home health, home care and hospice services in 21 states and five countries.

“I am a firm believer that building an infrastructure of cultural engagement is a smart investment and recognizing employee contributions that exemplify your values has a multiplier effect across the organization,” Knapp said. “Our high and stable employee experience data demonstrate that a strong, mission-driven culture can drive employee retention and satisfaction. That, in turn, has been correlated with better hiring, retention and productivity.”

Organizational culture is also significant for patients. Studies show that engaged and satisfied employees are more likely to provide high-quality care, resulting in better patient outcomes. Lower engagement rates can increase errors, solidifying that a weak culture is a liability for health care organizations. Moreover, a supportive culture promotes open communication, continuous learning and collaboration, all vital for patient care and safety.

Beyond employee and client satisfaction, culture contributes to a healthy bottom line by keeping caregivers in place and engaged, avoiding malpractice claims. Health care organizations with positive cultures attract and retain top talent, essential in an industry with significant workforce shortages. Additionally, a study by Gallup showed that companies that prioritize culture experienced a 33% increase in revenue.

Understanding the environment and taking action

Understanding the current environment is imperative before focusing on improving workplace culture. Michelle Cone, senior vice president of training and brand programs at HomeWell Care Services, recommends soliciting and acting on client and employee feedback.

“This is table stakes to gauge satisfaction, identify areas for improvement and solicit suggestions,” she told HHCN. “Use this data to shape strategies and make tangible changes when needed.”

HomeWell Care Services, based in Burkburnett, Texas, offers personal care, companionship, and homemaker services for seniors and other homebound individuals.

Providers can start by conducting anonymous surveys to gather honest feedback on various aspects of workplace culture, such as communication, collaboration and job satisfaction. A combination of quantitative and qualitative questions to gain a comprehensive understanding is best, according to sources.

After gathering the survey results, providers can then analyze the feedback, building on strengths and removing weaknesses – where possible.

Using focus groups to impact change after the fact is one way to respond to feedback.

“At HomeWell, our core values are integrity, collaboration, excellence, candor and balance,” Cone said. “We hire, reward, and recognize our core values. We also focus on setting clear expectations and providing support. This includes clearly defined roles, responsibilities, expectations and success metrics.”

The post The Levers Bayada, HomeWell Pull To Retain Home-Based Care Workers  appeared first on Home Health Care News.

More people than ever want to age in place, but payment and staffing concerns linger in the larger home-based care space. This emphasizes the need for scalable, efficient, high-quality solutions to meet the growing service demand. As a result, artificial intelligence  is emerging as a crucial tool. 

AI is a multifaceted field focused on creating systems that mimic and augment human intelligence. With AI comes the ability to learn, reason and solve problems. However, AI models rely on large data sets to learn, train and evolve, which can lead to privacy concerns.

“Home care agencies are actively reaching out to us to learn how we can help them care better and grow faster amidst caregiver shortages and rising costs,” Sensi.AI Co-Founder and CEO Romi Gubes told Home Health Care News.

Sensi.AI is an artificial intelligence company based in Tel Aviv-Yafo, Israel, with offices in the United States. It uses audio technology to detect unusual events in a client’s home and relays the information to the clinical care team. For a relatively young company, it is expanding quickly. The company raised $31 million in Series B funding earlier this year.

This high demand indicates that the home care industry is shifting from a heavily human-dependent model to one that will regularly leverage AI. Agencies that are feeling the pressure of caregiver shortages see AI as a necessary solution, according to Gubes.

“Sensi allows us to take care of more clients, especially those needing around-the-clock care,” Care Around the Block Chief Operating Officer Casey Rausin said. “Without it, providing 24/7 coverage for a client would require five to seven people, which is hard to staff. We can now identify and prioritize when a senior truly needs a human caregiver, and for the rest, we supplement with Sensi as a safety net.” 

Care Around the Block is a Knoxville, Tennessee-based provider of professional care management, home care and dementia care services.

AI can potentially transform the home-based care space by enhancing community-level care, connecting vulnerable populations with providers earlier and delivering tailored support for managing chronic conditions at home. Home care providers are uniquely positioned to act as proactive responders, addressing client needs before they escalate into crises that may lead to repeated hospitalizations.

A question of privacy

While AI offers numerous potential benefits and opportunities to provide better care, alleviate staffing shortages, and aggregate and analyze personal data, concerns arise regarding privacy and keeping that data out of the hands of the wrong people.

Gubes said that her company takes proactive measures to educate its customers, ensuring they fully understand how the technology works to address privacy concerns before they arise. She also noted that audio-based technology provides privacy advantages by avoiding invasive video surveillance, while still being able to focus on specific sounds or patterns that may indicate the need for intervention.

Yet, audio technology does not completely circumvent privacy concerns.

“We work with some AI providers that are using audio monitoring,” Angelo Spinola, the home health, home care and hospice chair at the Polsinelli law firm, told HHCN. “Some privacy laws are triggered, sometimes at a state level, that require consents and notices. Normally, you want a privacy policy and consent from the client, caregiver and also something for visitors.” 

Spinola advised that there should be some notice when other people in the home haven’t consented to being monitored and the device is passively monitoring those individuals.

“Then there’s the scope of that notice,” he said. “I think that is important as well. People need to know why they are being monitored. It may initially be intended to improve the quality of care, but if there are purposes related to the caregiver or employee, that should also be indicated.”

As AI plays a larger role in health care, it’s essential to pay attention to the Health Insurance Portability and Accountability Act (HIPAA). However, incorporating AI while ensuring HIPAA compliance can be challenging. AI applications need vast amounts of data for training, including sensitive health information. It is an essential but difficult task to ensure this data is properly de-identified to protect patient privacy while still being useful for AI.

Health care organizations using this technology should carefully work with developers to understand how these tools work to ensure they meet HIPAA standards. In addition, it is crucial to regularly update policies and procedures, implement strong security measures and monitor AI tools for compliance issues.

Technology shouldn’t replace the human element

While technology is undoubtedly an important tool in helping caregivers complete their jobs more efficiently, it is still only a tool. The humans behind the technology should still take ownership of how it is used and what safeguards are put in place.

“I think everyone in health care is learning and evolving how they think about and use AI,” Bayada President and Chief Operating Officer Heather Helle told HHCN. “AI has tremendous promise in application, not just for making the back-end office more efficient, but also in helping us think about streamlining clinical workflows.”

However, according to Helle, AI should be seen as a co-pilot for a caregiver or clinician in the home.

“When you look at the pace of adoption and the pace of change that AI is helping usher in, it’s much faster than we’ve seen typically in health care,” Helle said. “We have to be thoughtful about the risks that come with that and ensure we have the appropriate guardrails and manage that.”

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Home health providers have lately been hamstrung by payment rate cuts, staffing woes and Medicare Advantage (MA) penetration. However, despite these obstacles, the industry still holds significant potential and numerous untapped opportunities.

Looking ahead to 2025, it is anticipated that M&A, updated payment models, and innovations in staffing and retention will be key themes. Additionally, home health providers are keenly interested in artificial intelligence (AI) and its potential impact on care.

Anticipating an uptick in transactions

Since 2023, there has been a significant decline in the volume of transactions in home health care. This decline has been primarily attributed to inflation, uncertainty surrounding Medicare payment changes, high interest rates, and sellers’ reluctance to accept valuations considerably lower than the unprecedented highs seen during the pandemic.

This decrease in transaction volume over the past couple of years has resulted in a backlog of home care agencies looking to sell in the coming year, according to The LTM Group CEO David Kerns.

The LTM Group, based in Dayton, Ohio, provides home health, personal care, hospice, and rehabilitation services through multiple locations. The organization collaborates with health care systems and payers to deliver care to patients in Indiana, Ohio, Michigan and Texas.

Another significant factor that could be creating acquisition opportunities is the retirement of home health operators. Every day, over 11,000 Americans are turning 65, according to the American Association of Retired Persons.

“It is estimated that over the next few years, we will see one of the most significant business shifts from one generation to the next as local home care agency owners retire after having spent their entire lives building companies,” Kerns told Home Health Care News. “They want to see their legacy continued and this often means a sale to a larger organization.”

Reimbursement changes could lead to a promising future

An increase in the number of Medicare Advantage (MA) participants could lead to significant changes in the upcoming year, according to William A. Dombi, president of the National Association for Home Care & Hospice (NAHC).

Currently, providers are experiencing financial losses due to reimbursement rates, as the number of patients enrolled in MA continues to rise.

“I believe we’re reaching a point where plans are starting to be more open-minded, intelligent and willing to do two things: Listen to data on value and consider trying more innovative [approaches],” Dombi told HHCN.

Dombi believes that to see more positives in home health care, there must be a shift to updated payment models, rather than the per-visit discounted rates providers have worked with for years.

“If we don’t see this opportunity materialize and be realized, we will have an incredibly challenging future,” he said. “You can’t survive when a growing portion of your patient census costs more money than you’re bringing in. However, signs indicate that companies are finally realizing that trying to cut costs leads to poor results.”

Dombi said that states are realizing that reimbursing providers at a discount isn’t effective for staff retention. As a result, some are increasing payment rates to enable care agencies to pay a more livable wage.

“An opportunity lies in the continued improvement of reimbursement rates from state Medicaid programs as well,” Dombi said. “This will, to some extent, address the workforce shortage crisis, especially in the personal care attendant and home care aide sectors.”

The rise of AI

As the population ages, people are seeking more home care, whether for healing, rehabilitation, or personal care. This calls for staff that is currently in short supply. Thus, many organizations are turning to artificial intelligence (AI) to provide efficiencies, allowing caregivers to spend more time with patients and less time with paperwork.

“When evaluating potential acquisitions, we employ the fax machine method,” Kerns said. “This involves identifying manual processes such as faxing, hand-entering orders and manual authorizations – areas where our organization can add significant value post-acquisition.”

Over the past five years, The LTM Group has focused on automating processes and enhancing technological capabilities, according to Kerns. These automations include everything from revenue cycle to documentation.

While AI can assist providers with documentation, it can also keep physicians updated on their patients.

“AI in home care elevates and enhances the level of care available to our clients as they seek to age in place,” Bruce McReynolds, the CEO of a Griswold home care location, told HHCN. “We can better implement preventative services to keep our clients at home longer and prevent significant events that negatively impact their quality of life. From a business perspective, AI helps us speak the language of our partners in acute care. We can better demonstrate value within the overall care continuum.”

Griswold Home Care is a large non-medical home care company. McReynolds operates a location in Greensboro, North Carolina.

“We must establish connections with primary care physicians and monitor patients more closely,” Bayada President and Chief Operating Officer Heather Helle told Home Health Care News. “Overall, [with using AI], we will see a greater integration and coordination of care within the home, which is crucial for providing the best care for clients.”

Bayada, headquartered in Moorestown, New Jersey, provides a full range of clinical care and support services in the home for children and adults including hospice, behavioral health, and rehabilitation.

Helle believes the home care industry will continue to see new services, some of which may not be hands-on care, but other tools and technologies that help people thrive and live comfortably, independently and with dignity in their homes.

“Home care is an exciting sector to be a part of,” she said. “I think there’s a lot of growth opportunity and I think we’ve got a lot of tailwinds. It’s a great place to be right now.”

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Home health providers want better rates and arrangements from Medicare Advantage (MA) plans. The plans, on the other hand, sometimes still can’t figure out what they want from providers.

Some of the largest home health companies have begun to make headway with MA plans.

“I think the payers are recognizing that this is not a commodity business; there is a real need to partner with high-quality providers in the communities,” Pennant Group Inc. (Nasdaq: PNTG) CEO Brent Guerisoli recently said.

But a simple recognition of the value of home health care is not always sufficient, particularly within regional or nationwide plans.

Enhabit Inc. (NYSE: EHAB), for instance, has spent the last couple of years diversifying its revenue to include more of a MA mix. But, in doing so, it has had to get better rates from MA plans to ensure its bottom line doesn’t sink too far.

The company has been successful at that, agreeing to dozens of new contracts that have allowed it to inch closer to sustainability.

The negotiations haven’t always been easy.

I wrote last year about how some health plans didn’t even have point people specifically assigned to home health care, an obvious thorn in a provider’s side.

Enhabit CEO Barb Jacobsmeyer also explained Wednesday, at the Leerink Partners Healthcare Crossroads Conference, that even if there is a point person, they’re sometimes incentivized only to keep costs down.

“The most resistance is when you find that they’re siloed within their negotiating departments,” Jacobsmeyer said. “If it is the group that handles just home health, frankly, what we’ve learned is that they have a bonus, or incentive, to keep their unit cost in place. If they’re not talking across the hall with those that are focused on emergency room visit cost, acute care utilization costs, that’s where we see the barrier.”

I also wrote last summer about the leg up that home health-friendly MA plans would have in the future.

In order for there to be more “home health-friendly” MA plans, though, plans need to take a more holistic view of health care costs across the continuum.

Right now, that’s not always happening. And that’s the topic of this week’s exclusive, members-only HHCN+ Update.

A short-sighted view

Earlier this month, I spoke with CareCentrix CEO Steve Horowitz about post-acute care, payers and the friction between the stakeholders involved on each side.

He made something clear: Home health costs going up, generally, is a good thing.

“You actually want more home health,” Horowitz told me. “You want your home health costs to go up. You don’t want to overpay for anything, but you want your home health cost to go up, because it’s a cheaper setting than if you were taking care of the patient in the facility.”

Now a part of Walgreens Boots Alliance (Nasdaq: WBA), CareCentrix is a home-based care coordination platform, as well as a value-based care enabler.

If one department is squeezing down home health costs, they may believe they’re doing their jobs. But, on the other end, as Jacobsmeyer pointed out, emergency care and rehospitalization costs may be skyrocketing.

“I can cut home health costs in a heartbeat, or DME costs, or inpatient utilization,” Horowitz continued. “But every time you squeeze it, something else blows up. That’s the hard part, if you think about it only in a silo.”

To be fair to MA plans, the Centers for Medicare & Medicaid Services (CMS) arguably takes the same approach. Models like the Home Health Value-Based Purchasing (HHVBP) Model have saved Medicare billions, only for CMS to turn around and continue to cut home health payment rates.

That’s part of the reason why home health advocates have urged CMS, The Medicare Payment Advisory Commission (MedPAC) and others to take a more holistic view of home health payment. Advocates urge these groups to consider MA payments rates to home health agencies, but also the savings that greater home health access could bring to the entire health care system.

“As the nation faces a debt ceiling of $34 trillion and climbing, it’s no surprise that the federal government is under pressure to find ways to cut program costs and crack down on overspending,” a dozen home health advocate and provider voices wrote last week in an op-ed for HHCN. “What is surprising is that the program they continually target in budget cutbacks has an impressive record of saving the government billions: Medicare-certified home health care.”

That evoked something Michael Johnson – Bayada’s home health and hospice leader – told me last year, which is that all CMS policymakers have “is a hammer,” meaning that cost-cutting in home health care was their one vehicle to make a difference.

In MA, the little leverage that providers do have is the fact that plans need home health services for their patients, and access is dwindling with fee-for-service rate cuts.

Enhabit has drawn a hard line: It won’t take more than a 25% “discount” on rates from plans. That discount is compared to the fee-for-service Medicare rate. Instead of 40% discounts, Enhabit has achieved either episodic contracts or per visit contracts that are generally 10% to 25% below Medicare fee-for-service rates.

The company still prefers the more value-based, episodic arrangements, but those require collaboration between plan and provider.

“It really aligns their incentives with ours,” Jacobsmeyer said. “We want to be paid better, but we also want to help them where their pain points are, and that is having a timely and efficient movement of patients in institutional settings [back into the] home.”

It seems everyone knows – or assumes – that more responsible home health utilization equals lower costs for a population, whether that’s a small sample size or a nationwide one.

CareCentrix, which is in the middle of these arrangements, should be an authoritative voice on the subject.

But there are other experiments currently ongoing that should bear proof of that assumption. And that lies within the large payer organizations that own home health organizations, like Humana Inc. (NYSE: HUM) and UnitedHealth Group (NYSE: UNH).

Specifically, CenterWell President Sanjay Shetty told me earlier this year that one of his goals is to prove home health care’s worth to Humana – and everyone else.

Although some home health providers are queasy at the idea of these large payers owning top providers, they do offer hope in that way.

“It’s an opportunity for us to continue to evolve the thinking around home health, which is giving home health its due for driving outcomes along the entire continuum of care,” Shetty told me. “I think, hopefully, that proof point will help. The other thing that’s important to keep in mind is that CenterWell will never be able to provide 100% of care to all Humana members, even as big as we are. We are absolutely dependent on a broad payer network and a broad provider network.”

The post Payers Continue To Take Short-Sighted View Of Home Health Care appeared first on Home Health Care News.

As the nation faces a debt ceiling of $34 trillion and climbing, it’s no surprise that the federal government is under pressure to find ways to cut program costs and crack down on overspending.

What is surprising is that the program they continually target in budget cutbacks has an impressive record of saving the government billions: Medicare-certified home health care.

Though home health care helps nearly 36 million 65+ and permanently disabled Americans recover at home and avoid costlier placements in institutions, the Centers for Medicare & Medicaid Services (CMS) has initiated deep cuts to the Medicare home health industry, totaling $25 billion in cuts over the next decade.

Government-funded health care programs like Medicare, Medicaid and Medicare Advantage (MA) home health are closely connected in how they are financed.

This is because Medicaid and Medicare Advantage have such insufficient funding to begin with, forcing providers to rely on Medicare to cover the shortfall to offset the costs incurred in treating patients under Medicaid and Medicare Advantage – a decade-old system that is severely flawed and requires all three programs to ride on the backs of one another for financial stability.

The solution is two-fold: First, CMS must stop cutting Medicare home health care funding. Cutting funding year after year has only created turmoil in the very industry that is essential in providing stable, in-home care for vulnerable Americans.

Second, CMS and the Medicare Payment Advisory Council (MedPAC) must seek to develop new policy approaches that account for Medicare’s cost-savings and support a sustainable funding model for Medicare, Medicaid and MA. This two-fold solution will ensure that purported federal efforts to save money and cut programs are not done so to the detriment of millions of seniors and adults with permanent disabilities.

As funding cuts continue, the costs of business and operations increase, leaving home health providers forced to either cut wages, services and coverage areas or shut their doors altogether. This ultimately costs Medicare more money by pushing patients into costlier institutional settings while simultaneously risking health outcomes.

Medicare home health patients have better health outcomes and are at less risk for rehospitalization. Since COVID, we have seen a substantial shift in America’s future of health care as more evidence has shown home to be the safer and more comfortable setting. Without fixing the flawed system, vulnerable Americans won’t be able to access this option of care and our government will be forced to spend even more money.

To put it into perspective:

It costs $2,010 per month to care for a patient at home for 30 days under home health care.

A skilled nursing facility costs an astronomical $16,500 for that same care.

That’s a cost savings of approximately 88% for every patient diverted from a skilled nursing facility and cared for at home. Put another way, we can care for eight people at home for the cost of caring for one person in an institution.

Why does the federal government continue to put a target on the back of an industry that has shown to be a win-win for both patients and the federal budget?

Year after year, these seemingly baseless funding cuts destabilize the nation’s ability to move health care into the home, and further our growing debt. The federal government should be fixing this broken system by taking the money Medicare home health care saves and reinvesting it into a practical funding model that supports providers’ ability to expand access to these essential services.

In its Strategic Framework plan, CMS claims to have a “commitment to ensuring all American people have access to the highest quality health care.” The home health industry undeniably operates within that commitment, keeping America’s vulnerable populations cared for in the patient-preferred, cost-effective setting. We are finding it increasingly difficult to see how the federal government has lived up to that same promise.

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The Medicaid Access Rule has been finalized, with six years until the implementation of the 80-20 provision. There’s no time to rest for home-based care providers and advocates on the regulation front, however. Summer is near, and that means so is the home health proposed payment rule from the Centers for Medicare & Medicaid Services (CMS).

In 2022, a significant proposed cut to home health payment mostly took providers by surprise. In 2023, it was expected. And, unfortunately, the home health industry is expecting more of the same in the next proposal.

The counter to CMS’ rate cuts and attempted clawbacks remains the same in 2024, and it is all-encompassing: grassroots action from providers locally; a lawsuit against CMS and the U.S. Department of Health and Human Services (HHS); a push for Congressional support and direct pleas to CMS to rethink its methodologies.

In 2024, there’s already been a few major developments on those fronts.

For one, at the end of April, the National Association for Home Care & Hospice’s (NAHC) lawsuit against CMS – first filed in July of last year – was dismissed by a federal judge. Though an unfortunate update to the situation, NAHC President William A. Dombi proclaimed the legal battle far from over.

“We are disappointed with the court’s ruling,” Dombi said. “However, it is a minor setback that we can readily overcome. Often justice delayed is justice denied. Here, we will have our day in court. This battle is far from over.”

Meanwhile, last week, Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) sent a letter to CMS Administrator Chiquita Brooks-LaSure strongly advocating against further cuts to home health payment.

“We appreciate CMS’ commitment to helping people get the care they need, where they need it,” the senators wrote. “This must include home health services for people with Medicare. As CMS proceeds to develop Medicare home health payment rates for 2025, we urge you to consider the value home health care provides to the Medicare program and its beneficiaries.”

There’s a lot going on in Washington, D.C., this year. Providers and advocates will have to find a way to cut through the noise to get the attention of lawmakers with the ability to prevent further cuts.

This week’s members-only, HHCN+ Update focuses on the next five months in home health payment policy, and what the industry expects is ahead of them.

More cuts ahead

There’s not a provider I’ve talked to this year that expects anything but further proposed cuts in June or early July. That’s because CMS made it clear in last year’s final rule that there would be more to come on the cutting front.

Partnership for Quality Home Healthcare (PQHH) CEO Joanne Cunningham forecasted another “doomy, gloomy” home health policy landscape for 2024 in January.

But Cunningham also believes that 2024 being an election year works in the industry’s favor.

“We know that Congress in an election year is very keenly tuned into the needs of their constituents,” she told me. “We are very hopeful. With some of our Congressional advocates, we’re looking for solutions that could make their way into a package that Congress will undoubtedly be moving, dealing with Medicare provisions. Our goal is to make sure that home health is part of that.”

Previously, lawmakers have introduced the Preserving Access to Home Health Act. Similar bills were introduced in 2022 and 2023, both in the Senate and the House. The latest version would have mitigated cuts, and also forced The Medicare Payment Advisory Commission (MedPAC) to take a more holistic view at home health reimbursement by including Medicare Advantage (MA) payments.

After two years of cuts – a 2.890% cut last year, and a 3.925% cut the year before – providers would likely take any respite, but respite is not the goal.

CMS has proposed more severe cuts than it has finalized of late, allowing the overall aggregate payment adjustments to come in as slightly positive. But those positive adjustments are just positive on the surface, which is a story PQHH, NAHC and the provider community are trying to tell.

Since 2020, CMS has either implemented or announced over $19 billion in cuts through 2029, according to PQHH. As laid out on the chart above, these cuts will have a compounding effect over time.

CMS has dismissed providers’ access-to-care concerns over the last few years, and it has not wavered on its strategy.

“In working with folks from CMS, I find I’m generally very impressed with smart people trying to do good work,” Michael Johnson, the president of home health and hospice at Bayada, told me last year. “I always try to make sure I don’t vilify these folks, because I think they really are trying to do good work. But the primary tool they have is payment. All they have is a hammer. So, if you need a screw adjusted, you’re still using a hammer, and we know what the outcomes of that look like.”

Clawbacks

Providers are up against that hammer, and the result of it is the chart shown above.

But CMS is also attempting to claw back “overpayments” it made to providers in 2020-2022: $873 million in 2020, $1.2 billion in 2021 and $1.4 billion in 2022.

At this point, every year that the home health industry does not fully win its fight against CMS, the potential impact of cuts and clawbacks for future years gets worse.

VitalCaring President Luke James and I had a conversation about those clawbacks on stage last month at Home Health Care News’ Capital + Strategy conference.

“I hate to beat a dead horse, but this temporary payment adjustment, the longer it just sits out there and doesn’t get enacted – it’s just growing in terms of size,” James said. “I know we’ve been talking about it for three years. And I think we’ve become maybe somewhat numb to that. But the numbers are very large, and they’re like problems; they only get worse if they fester.”

I then asked if James would rather have those clawback cuts implemented now.

“I’d rather have them not implemented at all,” he continued. “I’d rather them see the failed logic that they’re applying. … But if they’re going to implement them, I think I’d rather take a rip-the-Band-Aid-off approach. Because a lack of certainty is what creates a really hard dealmaking market. Certainty – rather than a perpetuity of uncertainty – is a better place, in my opinion.”

At this point in the game, morale is certainly a part of the equation, almost as much as the nuts and bolts relating to fighting cuts. Providers have fought tooth and nail to both survive and advocate for over two years now.

Stabenow and Collins’ letter to CMS is further evidence of the bipartisan support the industry has in Washington, D.C.

But if 2024 isn’t the year that things turn for the better for home health providers, it will be tough to convince smaller providers that the fight is still worth it – yet again.

The post ‘Perpetuity Of Uncertainty’: Home Health Providers Await Another Poor Payment Proposal While Left In Limbo On Massive Clawbacks appeared first on Home Health Care News.

However, the metaphor is there for the taking when it comes to potential Medicaid policy.

“When the 80/20 rule came out, many of us saw this as a ‘Tale of Two Cities’ situation,” Dave Totaro, chief government affairs officer at Bayada Home Health Care, recently said during a Home Health Care News webinar. “On the one hand, we were thrilled that CMS was aligning with the industry on its overall goal of preserving and increasing access to care, improving quality health outcomes, and, even for the first time, addressing health equities.”

Watch (click here): 2024 Medicaid HCBS Outlook webinar

The rule Totaro’s comments refer to is the proposed rule that would, among other provisions, establish national maximum standards for certain appointment wait times for Medicaid enrollees, require states to conduct independent secret shopper surveys and mandate that states report every other year on the HCBS Quality Measure Set for their HCBS program.

The proposed rule would also require that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers. That’s opposed to expenses such as “administrative overhead or profit,” according to the agency.

“While that’s certainly well intentioned, that will have significant unintended consequences,” Totarto said.

The Moorestown, New Jersey-based Bayada is one of the largest home health providers in the country. The nonprofit has over 330 locations across 22 states and six other countries.

Currently, the rule is expected to be finalized sometime in the spring. The public comment window on the proposed rule received over 2,100 comments.

“While we understand and appreciate the linkage between caregiver wages and recruitment and retention, the non-uniformity of state program requirements and the disparity in reimbursement rates — both across and within states — preclude the implementation of a standard minimum percentage threshold for direct care workers’ compensation,” Darby Anderson, EVP and chief government relations officer for Addus HomeCare Corporation (Nasdaq: ADUS), wrote in a comment.

Since that comment window closed, HCBS providers have been preparing for the potential finalization of the 80/20 rule from CMS.

Although the possibility seems daunting, Totaro doesn’t believe providers will be stuck with the harshest of outcomes.

“We do expect that something will probably be published in the early spring period because the administration actually wants to get this thing done before the election year,” Totaro said. “What will that be? The consensus is it’s probably not going to be at [that 80% to 20% ratio] — but some type of lower ratio. And maybe a ratio with a three- to five-year plan to get to a higher ratio.”

Despite an optimistic outlook, some providers proactively took the proposed rule to heart and have begun to prepare for something that looks like the 80/20 rule.

“Putting on my operational hat here, the general theme here is that you’re going to have to adjust your business,” Care Advantage CEO Tim Hanold said. “Whether the message is coming from CMS or others, the perception of what a fair profit margin is in home care is the oxygen to this conversation. Regardless of how the 80/20 rule shakes out, you need to run your business keeping this in mind.”

Richmond, Virginia-based Care Advantage is a home-based care company that has more than 45 locations throughout Virginia, Maryland, Delaware, Washington, D.C., and North Carolina. The company offers both personal care and home health care services.

When the proposed rule was published, Hanold and his staff wasted no time. At first, Care Advantage modeled various scenarios to understand unit economics and tried to pinpoint exactly how much an hour of home care would cost in the Medicaid program under the proposed rule.

That process involved different populations, geographies, states and illnesses. After the modeling, Hanold came away with three essential elements for providers to succeed in this forecasting.

“One is that you need to scale in a material way,” Hanold said. “No. 2: You have to get consistent, healthy rate reimbursement — which is a bit out of our control. And No. 3 is OPEX containment. We would need to be much more selective in how we deploy our resources and assets serving this population [if the rule were finalized].”

The unreliable reimbursement rate environment will always throw a wrench into a provider’s ability to offer competitive wages. Beyond reimbursement, Hanold pointed to controllable elements within the business, such as caregiver volume through talent acquisition — a crucial factor for success.

“Caregiver volume through the talent acquisition function is a must-have,” Hanold said. “Caregiver utilization, retention, I’d argue these things go hand in hand. Practical improvements that can be made like maximizing caregiver experience, flexibility, a range of potential hours and geographies. Again, scale really helps a caregiver’s volume and the selection of the hours of work.”

Paying caregivers a competitive wage is “like a ticket to the ballgame,” Totaro said. It’s a given at this point.

“However, over the last several years, I think we’ve also come to realize that there are other factors that we have to address,” Totaro said. “The image of home care is something that needs to be improved. We have to fill the pipeline. There’s just not enough folks who are interested in this kind of service. Lastly, an issue that has risen to the top recently, has been safety and security issues. We have to make sure that the people who we care for who are going into these homes feel safe and secure.”

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Between keeping up with rising wages due to inflation and the cost of living, to offering adequate training and education to new hires, recruitment and retention is a constant battle for providers.

One area that has risen to the top of the priority list: workload management.

“The top priority is simple, but it’s hard to get right,” Amedisys Inc. (Nasdaq: AMED) Chief People Officer Adam Holton told Home Health Care News. “Our top priority is workload.”

Getting workload management right

The Baton Rouge, Louisiana-based Amedisys is home-based care company that operates in 37 states and the District of Columbia. The company offers home health and hospice, as well as high-acuity services in the home through its subsidiary, Contessa Health.

The primary reason for nurses who voluntarily leave Amedisys, whether within their first year of employment or following the first year, is attributed to workload, according to Holton.

That trend is not just an Amedisys problem either.

In a study published earlier this year by researchers at the National Council of State Boards of Nursing (NCSBN), more than half of over 50,000 registered nurses and licensed practical nurses reported an increase in their workload during the COVID-19 pandemic.

Similarly, a high rate reported feeling emotionally drained, used up, fatigued , burned out or at the end of their rope “a few times a week” or “every day.”

These issues were most pronounced, according to the study, among nurses with 10 or fewer years of experience. That burnout has resulted in an overall 3.3% decline in the U.S. nursing workforce during the past two years.

For home health and home care — where there is a shortage of about 250,000 nurses — that stress is felt all across the country.

In turn, providers are strategically navigating workload management for new and tenured home-based care workers.

“There is a vicious cycle that can exist in our industry,” Holton said. “In talking to peers, the challenge seems to be that most people will leave because of workload, go somewhere else where they probably got more money and face the same, if not worse, workload issues. The core of all of this is fixing that.”

At Amedisys, the onboarding plan is structured in a way that is very intentional and deliberate in preparing clinicians for what they will experience when they start taking patient visits.

A more recent strategy shift, Holton explained, is the provider has started to self-scout itself using retention numbers at care centers that have positive data points and negative data points.

“Where we have low turnover, it’s a positive cycle,” Holton said. “You’ve got a workload that is manageable, creates a better caregiver experience, which then leads to more discretionary effort and better productivity. Where we have care centers where historically there’s been high turnover, it’s this vicious cycle that is very hard to break.”

Part of Amedisys’ workforce strategy plan that’s been at the top of mind for Holton this year has included “overseeding” with clinical hires in some areas to break that vicious cycle that the combination of high workload and turnover perpetuates.

“We have been systematically identifying the biggest pain points in high-volume roles and addressing them through technology, standardizing work and shifting tasks that are better executed by other groups,” Holton said.

What caregivers want

Workload management efforts also include making sure matching a caregiver to a patient is as seamless as possible.

“That all ties in with this idea of matching clients to caregivers,” Bayada Chief People Officer Jeff Knapp told HHCN. “We have to make sure that it’s not only a good match personality-wise, but it’s also matching the needs of the caregiver.”

The Moorestown, New Jersey-based Bayada is also one of the largest home health providers in the country. It has over 360 locations across 23 states and six other countries.

Many of the industry’s caregivers — Bayada’s included — work for three or four different providers at a time to essentially hedge their bets to find a good balance between workload, pay and other benefits.

For providers that want caregivers to stick around, it’s up to their workload management efforts to ensure they can provide the kind of work that will keep a caregiver on their payroll.

“I hear from caregivers all the time that say, ‘I don’t want to put all my eggs in one basket,’” Knapp said. “And for Bayada and our purposes, we would really love for caregivers to put all their eggs in our basket. So if we can do a better job of making them comfortable, ensuring that we’re going to be able to fill their desired work schedule and give them the hours that are convenient for them and their families, then that’s a win-win for everybody. So we are putting a lot of emphasis on that, too.”

In years past, businesses could be much more selective in the way they hire. Pre-pandemic, the employer held most of the leverage. Now that’s changed significantly.

“That’s never really been completely true in home care anyway, but now that’s flipped on its head,” Knapp said. “Our intentional understanding is we have to make it so that we are responding to the needs and the desires of the caregiver and making it easy for them to say, ‘I want to work this many hours a week, but I can only work from between this time and this time and within this geographical area.’ And we have to be able to make it easy for you to do that.”

For Bayada, the strategic shift is instilling some of those guarantees in the caregivers that are already on staff as a retention tool. Knapp said there is “untapped potential” and capacity in the caregiver pool already on the payroll.

“I think there’s a lot of untapped capacity in people who already work for us who are hedging their bets because they don’t have confidence that we can fill those other shifts,” he said. “Or that we can provide for them in the way that they want.”

As providers, proving to caregivers that they can provide a level of security is a big priority.

Technology also plays a role. Bayada is trying to make it easier on caregivers to alter their schedule or find a replacement if a shift can’t be covered.

“In the old days, if you had a sick child or a family emergency, it was a whole thing if you called off and had to wait to hear back and wait for someone to call you,” Knapp said. “Versus now where you can just go on your device and say, ‘Hey, I need help.’ Everyone sees it and covering that shift is so much easier.”

Buzzwords like engagement, satisfaction and fulfillment are thrown around often in home care, but these little differences and changes are what add up in the caregiver experience equation.

“All these things are pieces to the puzzle that make a person stay at an organization because the provider is making it easy to work for them,” Knapp said.

Holton has heard the adage that people don’t leave organizations, they leave managers. Certainly, the manager has a huge impact on the caregiver experience, he said, but in home-based care where there is more work than people that can do the work, people don’t leave managers — they leave workload.

“If you can figure out the workload,” Holton said, “you’re going to keep them.”

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