Before joining Vivo Infusion, Rodgers was CEO at AccentCare for over a decade. He was also formerly CEO of OptumHealth Collaborative Care, a division of UnitedHealth Group (NYSE: UNH) that owns, manages, and provides administrative and technology services to health care delivery systems.

Earlier in his career, he was a health care executive at General Electric, responsible for purchasing health care benefits.

Vivo Infusion provides cost-effective infusion care to patients in partnership with their physicians.

Accra names Frette as chief solutions officer, Chad Derner CFO

Accra has named LeAnn Frette as chief solutions officer. Frette transitions to her new role after serving as chief financial officer (CFO) for over a decade. The company has also appointed Chad Derner to succeed Frette as CFO.

“Over 18 years of service at Accra, LeAnne has guided our organization through tremendous growth and helped us maintain financial success despite constant disruption in the home care industry,” said Accra President and CEO John Dahm said in a statement. “Her expertise will be critical in clearing the future hurdles we face to best serve the thousands of Minnesotans who need care at home.”

Accra is a nonprofit organization providing individualized home care services to people with disabilities and older adults. Headquartered in Minnetonka and operating in all counties throughout Minnesota, Accra helps people who need care get self-directed assistance with activities of daily living.

As chief solutions officer, Frette will partner with leadership on all operational and strategic issues and provide recommendations based on financial analysis and projections, cost identification and allocation, and revenue/expense analysis.

“I am excited to dive into my new role as chief solutions officer and look forward to collaborating with Accra’s executive leadership team on strategies to build an ecosystem that better meets the needs of Minnesotans who require personalized care at home,” Frette said.

Frette started with Accra as a system analyst in 2006 and supported the company’s growth by building out its financial operating systems and practices. She was named CFO in 2014.

Taking on Frette’s former role as CFO, Chad Derner will manage Accra’s accounting and billing departments, oversee all financial activities and operations and provide strategic guidance to leadership. Derner joins Accra with 25 years of experience in finance and accounting, the last 16 of which have been in leadership.

“I am thrilled to welcome Chad Derner as Accra’s new CFO,” Frette said. “Having dedicated many years to this role, I understand the importance of having a leader with Chad’s extensive experience and strategic vision. I am confident that Chad’s broad health care experience will help Accra grow and thrive in our ever-changing industry.”

Derner will focus on identifying opportunities to optimize financial strategies across all of Accra’s business ventures. He will be critical in ensuring Accra fosters financial excellence and strategic growth.

“I am excited to join this dedicated team and contribute to Accra’s mission by ensuring financial excellence and strategic growth,” Derner said. “I look forward to leveraging my experience in financial management and technology-focused health care to support Accra and significantly impact our community.”

CaringBridge announces new board members

CaringBridge, a Bloomington, Minnesota-based health care platform supporting family caregivers, recently announced new members to its board of directors: Sandy Chung, American Academy of Pediatrics immediate past president, CEO of Trusted Doctors, Medical Director of the Virginia Mental Health Access Program; Kristy Lindquist, co-founder and partner at Chasm Partners and Steve Margolis, retired health plan executive, independent board member and current president of the Vitality Group.

The company also announced that retired health care executive Sarah Krevens was the board chair, and Linda Ireland, an independent board director, was the board vice chair.

Calvin Allen, executive vice president and chief human resources officer at Children’s Hospital of Philadelphia has joined as Treasurer, Finance & Development Committee chair.

Cris Ross, chief information officer at Mayo Clinic, is the new Impact Committee chair.

Adrian Slobin, chief growth officer at Huron Consulting, has joined as the Governance Committee chair.

Scott Spiker, board director and chairman at First Command Financial Services, is board chair Emeritus.

“I am thrilled to welcome our new members to the CaringBridge board,” CEO Tia Newcomer said in a statement. “Our board comprises seasoned professionals in health care with deeply personal connections to caregiving. I am truly excited about the future and what we will accomplish together. The board is essential in continuing our path of meaningful and transformational work to surround family caregivers with emotional, social and functional support as they care for a loved one on a health journey.”

nVoq welcomes Iddings as chief revenue officer

nVoq announced Dawn Iddings as its chief revenue officer. Iddings brings over 20 years of experience in health care, technology and electronic health records. Most recently, she served as senior vice president and managing director of post-acute care at Netsmart Technologies. 

“Dawn is an incredible addition to our executive team,” President and Chief Operating Officer Debbi Gillotti said in a statement. “Her deep expertise in the in-home health care market, combined with her career-long commitment to creating technology solutions for our industry, will elevate our ability to service our agency customers and industry partners.”

nVoq Inc., headquartered in Boulder, Colorado, provides HIPAA-compliant, SaaS-based technology for the in-home health care industry.

“The in-home health care market is on the brink of a significant transformation, and AI is at the heart of it,” Iddings said in a statement. “nVoq has been developing and evolving this technology to meet the unique needs of clinicians for over a decade. Our solutions continue to redefine efficiency, quality and accuracy in clinical documentation, and I’m thrilled to be a part of this journey.”

One Senior Care expands executive leadership team

Erie, Pennsylvania-based One Senior Care announced the expansion of its leadership team.

As chief medical officer, Dr. Jerry Wilborn, a 25-year veteran in post-acute care, will work alongside the organization’s medical directors to drive clinical strategy and positive health outcomes.

“Over the last few years, it’s become increasingly clear that seniors want to age in their homes. One Senior Care is making this a reality for the older adults we serve in Pennsylvania, Virginia, Kentucky, and soon, Ohio,” Wilborn said in a press release.

The newly appointed chief operating officer, Craig Worland, brings a professional background in leading growing health organizations, having previously served in Southeast Primary Care Partners and Tanner Health System.

“I’m honored to join One Senior Care, which has great potential to expand this truly integrated and participant-centered program to serve more older adults and communities across the country,” Worland said in a press release.

As chief quality and compliance officer, Laura Lyons will enhance the company’s quality and compliance programs, according to the release.

“As we look toward the future, we look forward to building upon our reputation in quality care and continuing to ensure that older adults can live healthy, happy and independent lives in their own homes and communities,” Lyons said.

Element Care appoints Thompson new CEO

Element Care announced the appointment of Douglas Thompson as chief executive officer (CEO). Doug brings experience in health care leadership, financial management and community engagement to the company.

“In seeking a new CEO, it was essential to the board of directors to select a candidate that not only has the leadership and technical skills necessary to manage such a complex organization but also someone committed to providing high-quality health care to low-income seniors,” President of the Board of Directors, John Feehan said in a statement. “We are extremely excited to have Doug join the Element Care team and look forward to working with him to bring high-quality, wrap-around medical services to many more seniors in need.”

Element Care, based in Lynn, Massachusetts, provides managed care for senior care options (SCO) under a contract with Commonwealth Care Alliance. The company serves over 1,000 Program for All-Inclusive Care for the Elderly (PACE) participants and 2,000 SCO members across 60 North Shore, Merrimack Valley and Greater Boston communities.

“I’ve worked with diverse populations throughout my career and am passionate about developing innovative programs to serve patients with complex health needs,” Thompson said. “I am excited about the mission and high quality of health care that is the foundation of Element Care. I look forward to building on the success of this organization and leading its next chapter as the population of aging seniors continues to grow.”

Thompson was previously the CEO and founder of Perfect Health Inc., where he developed a comprehensive primary care clinical model as a risk-bearing provider organization focused on serving seniors with complex health care needs at home. He was also the former chief financial officer of the Massachusetts state Medicaid program and three Medicaid managed care organizations.

Avenues Home Care welcomes Hendrix as senior care coordinator

Avenues Home Care announced Grant Hendrix as senior care coordinator for northwest Georgia and southeast Tennessee. Hendrix will help families and veterans living in Dalton, Chattanooga and surrounding areas engage with home care services to meet their needs.

“At Avenues Home Care, we are committed to offering those we serve professional, compassionate and flexible home care solutions,” CEO Doug Markham said in a press release. “With our years of experience and industry knowledge, we empower our local teams to foster meaningful connections within the community. Grant’s extensive experience, education, and the Avenues’ vision and support give him the essential insights and resources to ensure we meet our clients’ distinct needs.”

Dalton, Georgia-based Avenues Home Care is the parent company of community-centric home care agencies spanning multiple communities across the South. The company provides in-home senior care, activities of daily living, medication assistance, meal preparation, companionship, transportation, light housekeeping and more.

“Avenues’ motto, ‘your journey, our care,’ is something I will strive to remember every time I visit families and their loved ones,” Hendrix said. “My passion is to connect people to exceptional home care services that will help improve their quality of life. With their excellent reputation and resources, Avenues Home Care has given me a great opportunity to help families in the areas we serve.”

In his new role, Hendrix will analyze the market, visit communities and meet with clients in their homes.

Integrated Home Care Services Inc. welcomes Ajani Nimmagadda as CMO

Integrated Home Care Services Inc. (IHCS) announced that Dr. Ajani Nimmagadda has been named the organization’s new chief medical officer. Nimmagadda will assume clinical and medical management leadership across the organization.

“Dr. Nimmagadda’s leadership in driving clinical outcomes, quality of care and health care affordability will be instrumental in helping us continue to fulfill our mission and support our continued growth,” CEO Christopher Bradbury said in a statement. “Her proven track record of achieving better outcomes for patients, providers, and health plans and her expertise across the health care ecosystem will further accelerate our innovation and value-based care solutions.”

Integrated Home Care Services is a home care benefit manager that enables and accelerates value-based home care for health plans and risk-based provider organizations. Headquartered in Miramar, Florida, the company services millions of patients across many states and Puerto Rico.

“I am honored to join IHCS as chief medical officer,” Dr. Nimmagadda said. “I look forward to leveraging my experience in successful health care operations and improved operational efficiency while optimizing clinical outcomes. IHCS’s approach is reinventing home care benefit management, replacing fragmented approaches with an integrated, insights-based, coordinated model that improves clinical outcomes and patient experience and reduces health care costs. Improving care in the home has always been a passion of mine, and I look forward to unlocking the full potential of care in the home with our team members, providers, caregivers and health plan partners.”

Dr. Nimmagadda has nearly three decades of experience in health care, both as a practicing internal medicine and infectious diseases physician and as a health care executive.

Most recently, she served in various leadership roles at Cigna Healthcare, overseeing comprehensive medical and pharmacy utilization management programs and specialty drug clinical programs, including gene therapies.

The post Former AccentCare CEO Joins Vivo Infusion; Accra Names New CFO appeared first on Home Health Care News.

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.”

The post How Enhabit, Bayada Win Home Health Value-Based Care Arrangements appeared first on Home Health Care News.

Home health providers often pursue value-based care arrangements, with the goal of delivering quality care and achieving monetary success. But if they are not careful, these companies can also land in financial hot water.

“In a value-based arrangement, a financial disaster means I’m now losing money,” Joseph Furtado, administrator of MD Home Health, told Home Health Care News.

MD Home Health is a privately-owned Phoenix-based provider that offers traditional skilled services in the home, as well as specialty programs and non-medical personal care services through its MD Home Assist arm. The company is one of largest home health providers in Arizona.

Even for the providers highly focused on value-based arrangements, those arrangements tend to make up a smaller part of their revenue. But that may change in the near-term future.

In 2022, almost 42% of home-based care providers predicted that value-based contracts would make up more than half, or most, of their organization’s revenue in the next three to five years, according to a survey conducted by Home Health Care News and AlayaCare.

Additionally, 23% of providers projected that value-based contracts will make up about half of their revenue in the future.

Plus, Medicare-certified home health providers already operate under the Home Health Value-Based Purchasing (HHVBP) Model, which ties financial incentive to performance.

When entering a value-based arrangement, the problems can begin as early as the negotiation phase, if the home health provider enters the conversation without the correct data, according to Furtado.

“It’s typically a one-sided negotiation, because they have the data on what’s going on with your patients, they have the data on what’s going on with their patients, they have the data on what’s going on with everyone’s patients, and all you have is what’s going on with your patients, and it’s typically not very good data,” he said.

Furtado urges home health providers to not just trust their own data blindly. Instead, he advises providers to get their data validated.

“You have to get your data validated, and it can’t be validated by the local accountant, or the local bookkeeper,” Furtado said. “It has to be validated by experts in our field. You have to have consultants who are experts to help you because the financial disaster is not just the money you’re going to lose on those visits, it is the opportunity cost that you’re losing by not being able to take other arrangements that are going to be profitable for the agency.”

Chris Bradbury, CEO of Integrated Home Care Services, believes that one of the common reasons that value-based care arrangements end up in financial disaster for providers is structural issues around scale.

“If they’re asked to go from one territory to a whole state, to 10%, 20%, 30%, 40% of their business, and if scalability isn’t part of the initial design and agreement, there’s a real risk that problems could happen later on,” Bradbury told HHCN. “An agreement may be successful, and then a health plan may decide to throw gasoline on the fire. If the home health provider hasn’t thought through how to scale it, they could agree to scale rapidly, and not be in a position to consistently deliver the results that are in the pilot or the proof of concept.”

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 agreeing to a value-based arrangement without figuring out how to scale could lead to significant financial risk, and also damage the relationship.

Another factor that can put providers in a bad position financially is underestimating their true cost of care.

“It’s like saying, ‘Oh, my monthly bills are $3,000 a month because that’s my mortgage,’” Furtado said. “Well, it costs a lot more to run your house, right?”

Furtado explained that there are many factors that add up to the cost of providing care.

“When you start adding everything together — what you’re paying your people for mileage, what you pay for bonuses, what you pay for recruitment, training, missed visits — there are so many variables,” he said. “When you add it all together, your true cost of providing every visit is so dramatically higher. When you go and sit in these negotiations, you have a number in your head. ‘As long as I’m making $110 a visit,’ for example. Then they come in, and they tell you what they’re willing to give you. It’s going to be less than that.”

One way to make value-based arrangements work is to keep things simple, according to Bradbury.

“It’s very easy to make the metrics, the definitions and the flow of incentives too complex,” he said. “The greater the complexity, the greater the chance for misunderstanding, which then can lead to back-end problems and back-end risks.”

Bradbury advises providers dipping their toe in value-based arrangements for the first time to start small.

“Start in a particular area, prove the concept out, and then expand from there,” he said. “You have to be very careful about implementing something across your entire book of business, right out of the gate.”

It’s also important for providers to thoroughly vet the organization that they want to partner with.

“There needs to be a culture on both sides of test and learn,” Bradbury said. “Of curiosity, of discovery and a willingness and openness to adjust the relationship as it goes, based upon the performance and the insights and the value that’s delivered from these things, because it’s very important that all parties succeed.”

The post How Home Health Providers Can Avoid ‘Financial Disaster’ In Value-Based Arrangements appeared first on Home Health Care News.

Helping these kinds of home-based care companies see success in these arrangements has become Integrated Home Care Services’ sweet spot as a driver of value-based care.

Paul Pino, co-founder and chief growth and analytics officer at Integrated Home Care Services, recently joined Home Health Care News’ Disrupt podcast to talk about the roadblocks smaller providers face when trying to enter value-based care arrangements, and how his company helps navigate these challenges.

During the conversation, Pino also explained why working with each individual managed care plan is a unique experience, and touched on what the future could look like for home-based, value-based care.

Below is that conversation, edited for length and clarity.

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HHCN: For those who don’t know, can you share a little bit about your journey in home-based care and your role with Integrated?

Pino: I came to home-based care about 20 years ago. I had been a corporate investment banker. I had started doing deals, or transactions, within the home care space, and I was introduced to someone within the home care sector. We decided to go into business together.

I joined that first business in the early 2000s. We grew it. It was a fully capitated home health, home infusion and DME company that contracted with Medicare Advantage and managed Medicaid payers. I believe we sold that company around 2012. In 2015, my partners and I came back into the market and we founded Integrated Home Care Services.

Today we’re really focused on value-based care. How does Integrated Home Care Services fit into the value-based care picture? How are you trying to advance this area forward, so to speak?

When we speak about the topic of value-based care, it appears that everyone has a different opinion on what value-based care is.

I would say that back about 20 years ago, value-based care was limited to capitated risk-based agreements, where in which the value was derived from an alignment in payment methodology from payers. Now, IHCS is a traditionally – or a largely – capitated vendor, although we have different payment types and different payment arrangements that include other types of value-based oriented revenue streams.

If you think about touch caps, if you think about capitation with reconciliations and other threshold-based payment arrangements, we handle all of those. But what we really find is of significant value is not just a payment arrangement. From our perspective, every one of our contracts has significant SLA associated with them. That includes specifications around quality, specifications around turnaround times, and compliance and other metrics, that our plan partners, our providers – and more importantly – our patients all appreciate and derive some sort of value from.

I totally agree when you say that everybody has their own perception of what it means to deliver value-based care. Some people really fixate on the quality component, some people really fixate on the cost component. At the end of the day, value-based care is really all of it together.

I agree 100%, it has to be all of it. You need high quality, you need speed and you need some sort of financial arrangement that makes sense for all people, right?

You really want to incentivize the right type of care, not just an abundance of care. There’s additional fee-for-service models, right? There’s people that are coming in and just performing services. They’re performing those services so that they can be compensated, but traditionally, there is no tie in to outcomes and to other performance metrics. When you think about the way that a managed care plan that has experience in value-based care, they’re also tying folks that manage the home care benefit to many more value-based oriented criteria.

Similar to ‘everybody has their own definition of value-based care.’ I think a lot of people care about different outcomes and different metrics. I think that rehospitalization rate is obviously a really big one. I think the rate of missed visits into the home is one I’ve heard talked about more. What are some of the most important outcomes metrics?

There’s an old saying that if you’ve worked with one managed care plan, you’ve only worked with one managed care plan. I think they all have their specific views around utilization and other parameters that they feel are most important.

One of the things that’s often missed, as we talk about this post-acute care space … we think a lot about diversion, right? Think about pre-acute, think about the fact that there are patients out there that are suffering from chronic condition sets that require very basic types of medical equipment or other items, or some sort of intervention. When you have the availability of services — we view DME, home health, home infusion, LTSS, and PDN as all part of our service offering — you’re really able to pivot and do what’s right for the patient at any point in time. With a simple phone call to IHCS, either a care coordinator at a health plan, or a physician or other folks can just reach out to us and make sure that a patient that doesn’t need to present it in the emergency room is seen.

You’ve seen a lot of activity recently in terms of mandates coming down from CMS. You’ve seen the recent view around the managed care rules, everyone has an opinion. The states have been doing all of this care coordination in lieu of service type business for many years.

Right now, what we find is that the services that we’ve been performing on the front end to make sure that a patient is seen and seen quickly, we’re already working around what we believe is to be the appropriate and most expeditious way of serving a member before they present. As you indicated, though, when you think about readmissions, there’s this misconception around them. In many instances, especially if you’re looking at Medicare Advantage plans or other traditional fee-for-service payer, what you’ll find is that many of the plans are not necessarily on the hook for the readmission. You’ll find that, in many cases, the hospital and the methodology of payment under some sort of traditional DRG-like structure, they’re on the hook.

What we find is that it’s not just about readmissions, in terms of cost savings, but it really is about the patient journey around whether or not a readmission is avoidable. A lot of people just focus on the cost structure. Having a patient re-present, having a patient potentially have a hospital-acquired condition that comes into their life, and also what you see in terms of the dislocation from that patient’s home and their family, all those things are high-quality oriented issues that don’t necessarily, in every instance, cost the plan additional money.

What would you say some of the biggest challenges are today for home-based care providers when trying to seek out these value-based care opportunities, and then do well in them if they enter into one of these arrangements?

Realistically speaking, what we find when we’re thinking about smaller providers that want to work with us under a value-based arrangement, is a lack of capacity to serve an entire population.

When you’re thinking about your traditional value-based arrangement, you have someone that says, “Hey, I’m going to take this book, or this geography, or this group of patients, and I’m going to perform X, Y, or Z. The results that I yield will provide X, Y, and Z as well.” What we find is that a lack of capacity to serve large swaths of a population can really slow down someone’s ability to have some sort of true value-based arrangement. Now, if the value-based arrangement with a plan is focused on a quality-only component then, quite frankly, the issue that they have is getting a network management person to sign a contract that’s unique, and to come up with an appropriate reimbursement structure for that provider, when they have so many other provider network agreements that they have to configure. It’s really understanding whether or not you can make a significant enough dent to garner some sort of unique contract.

If I’m that person with the managed care plan, setting up a value-based care arrangement, do I just copy and paste the language from one home-based care provider to another, or am I really trying to cater it to what that provider does well?

Nine times out of ten, there’s a standard network agreement, and the only thing that changes within the network agreement is specifically around reimbursement. What you’ll find is, “Hey, here’s our agreement. Here’s a provider fee schedule associated with the agreement.”

Now at IHCS, we have the ability to customize down to the provider level. We have the ability to set up rules in place and other conditions, where a value-based arrangement with a downstream provider is something that we’re more than willing to do, given the appropriate parameters. For us, one of the most important components of our service offering and the manner in which we contract with payers, is the time to staff.

If you think about the speed in which one is required to staff in order to be able to adequately discharge a patient in a coordinated fashion, so that that patient doesn’t re-present within the emergency room, or any any facet of the hospital, or inpatient setting, we need to coordinate all lines of business. If you think of a home health agency that needs to show up after the infusion medication gets there, that infusion medication needs to get there after the patients in the hospital bed. All these functions are things that require coordination.

When you have an entity like ours that’s working with multiple providers to make sure that we’re getting the most appropriate provider out there, as quickly as possible, these things can change. We’re not looking for the easiest provider to call, we’re looking for the best provider to call. In almost all of our arrangements, when we go live, and in almost all of our utilization, small to regional providers have the bulk of our business. Our competitors have a significant amount of exposure, and services being provided by large national home care entities, and by large national DME companies.

When you think about the way that our network participants are assembled, it really is different, we really do focus on the smaller entities. From our standpoint, customizing around those smaller entities and making sure that those entities understand the potential volume that they’re going to be receiving really makes a significant impact for them, in terms of planning. It also allows us to really plan around the ability to meet our SLAs on discharges.

Can you walk me through a real world example of a value-based care arrangement in home-based care?

We recently went into the market of South Carolina in a very large way. What we recognized before going into that market was that there were significant concentrations of utilization, specifically around home health, that were being directed to entities that may not have necessarily had certain utilization patterns that we wanted to continue.

We set up parameters, working relationships and guarantees around quality and staffing, and speed to staffing and communication with a core group of network participants that you would consider to be regional to small entities. With those arrangements in place, and with their clinical reporting, we have found that we have right size utilization to the point where these entities are always busy now. They’re not busy with turning around the same patient over and over. They’re meeting their goals, and then they’re receiving additional referrals. What we’ve seen with certain entities is the ability not only to come up with a methodology in which they want it to contract, but also deliver on the promises of “If you need us to staff, we will make someone available to staff. As long as we agree that if we continue to perform this way, we will continue to receive the amount of volume that we’re receiving.”

Those types of arrangements with these providers — there’s some that we’ve looked at now that have grown tenfold, in terms of volume that they’re receiving from this specific planned cohort. We’re really excited for them, and they’re really excited about working with us.

How do you see the future of value-based care in home-based care contexts evolving, as we look ahead at 2025, 2026, five years from now?

Let me start with a little bit about our team. Our team has a significant amount of managed care experience, we have provider expertise. Our home care leads … have over 30 years in certain instances, and certainly over 20 years in provider-oriented experience. Our senior team has a significant amount of managed care experience, coming from a diverse background. I’ve personally had the opportunity to establish and build out a large primary care risk-based MSO..

When you think about value-based care, what you need to start with is who is responsible for the dollar value of what’s being provided, and then ultimately, who is accountable to make sure that those dollars are adequately allocated? When you think through that component, then you start making assessments around, what is it that you’re going to be able to do to positively impact those stakeholders, by positively impacting all other components of care? In our specific case, we’ve started working very closely with risk-based entities. When we start speaking to them about how they want us to grow alongside them, what we have found is that the value-based arrangement and environment that we see evolving is going to be one that goes outside of your traditional skilled home-based care.

What we find is that we are being pushed more and more to make sure that we’re looking at whole-person care, that we’re looking at what specific things a member needs, in order to be able to be home. This includes components of contracting around identifying certain aspects of what’s happening within the home, whether it be food insufficiency, whether it be loneliness, whether it be, believe it or not, electricity. All those components, I believe, are going to become more and more salient as we see true value unlocked within the home setting.

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Choices, CEO Chris Bradbury said, that are well thought out and driven by data. And choices that are strategically sound.

Take, for instance, the three areas IHCS is involved in: home health, home infusion and durable medical equipment.

“We chose those for a reason,” Bradbury told Home Health Care News “The reason is many of the patients coming out of the hospital or from a facility use all three, or use two. Not all, but I was with one of our largest clients recently, and we found that one-third of their home health users also use DME. Two-thirds of their DME users also use home health.”

IHCS is a driver of value-based care, through durable medical equipment, home health care and home infusion management. The company serves managed care plans and its members. Its model streamlines hospital discharges and care coordination.

When patients are discharged from the hospital, the coordination aspect post-facility can be daunting and confusing.

IHCS is trying to simplify that process while also providing quality and efficient care in a timely manner.

“It’s rare that we provide only one of those services,” Bradbury said. “I want to only provide those three services, and part of the reason being is that it’s a single point of contact for the hospital, the provider, the patient and their family. They just work with us. We take care of the coordination across all of those service lines, and we’re at risk for that, which makes that transition of care to the home … a lot easier.”

Another big choice IHCS has had to make: investing in data.

Bradbury said companies like IHCS need to make data collection and utilization a priority to ensure their partnerships with health systems continue to evolve.

“We’re constantly asking ourselves how to make the complex things easy to understand,” he said. “We really want to understand — within a health plan — their programs, their services and their analytics groups about what slices of data or insights can add value to their programs. We’re in a unique position to do that — and it’s a choice.”

The home care industry, Bradbury told HHCN, is in “the second or third inning” of utilizing data to its fullest potential. There’s also an opportunity to collect data in places that might be outside of the typical places a caregiver might collect it.

“Every time we’re in the home, it’s an opportunity to observe and ask additional questions that are appropriate for the role that we’re there for, but may not be germane to what [they’ve] been hired to do,” Bradbury said. “But there might be questions we know could be really important for the case manager.”

Or for payer partners, he continued.

Data can also be a way to have real-time monitoring of the patient’s overall satisfaction, which is critical in today’s value-based environment where satisfaction is tied to financial gains or losses.

“It’s filling in blind spots,” Bradbury said. “It’s providing different data insights that really are intended to support the health plan strategy.”

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But most industry leaders still believe there is a long road to get there.

“Today, the landscape is crappy,” Bruce Greenstein, chief strategy and innovation officer at LHC Group, said on a panel during the Home Care Innovation + Investment Conference in Chicago earlier this month. “We’re a big provider first, so despite the fact that I work with conveners today, we care most about our world as a big provider across 39 states. When a big provider moves towards using a convener, there are many opportunities for us to just withdraw from the relationship. It causes so much friction.”

The Lafayette, Louisiana-based LHC Group delivers home health, hospice and home- and community-based care in 37 states and the District of Columbia through 527 locations.

Broadly, conveners are the middlemen between home-based care providers and MA plans. LHC Group is sister company with one now that it is under the Optum umbrella. naviHealth – now Care Transitions – is also owned by Optum.

When done correctly, conveners and home health provider relationships begin with the patient in mind. That’s where most of the conversations and negotiations have started for Integrated Home Care Services, according to CEO Chris Bradbury.

“One of the first talking points for us has been how to get timely access to care so people can get to the home because that’s where they want to be to achieve their goals, not our goals,” Bradbury said. “Number two is to achieve the clinical outcomes that we are all trying to achieve. The patient’s goals — not the provider goals, not the payer goals, or the convener goals. And those are often clinical goals, but they can be other things as we move into the home and serve the family.”

Conveners and providers are generally not on the same page.

But Bradbury also mentioned that patient satisfaction and ease of administration are other goals that should be shared between the two.

It’s not always that simple for providers, though, according to Greenstein.

“Chris just painted a picture where, if it really worked that way, we would be enjoying these relationships,” Greenstein said. “We have, for the first time, substantial leverage if the goal is to manage the total cost of care. As we move forward, we do have to think about, ‘What does the total cost of care and risk look like?’ It’s one thing if conveners stay in a narrow line of expenditures in trying to push down the home health spend on behalf of a payer. The advantage comes when the convener is responsible for all of the post-acute care cost, and we could finally see some recognition of the migration from more expensive settings of care to home health.”

It’s not just Greenstein. Many home health leaders have suggested conveners need to change the way they do business.

Bradbury sees Integrated Home Care Services as an evolving company, but also one that gets the convener mission right.

“How we think about who we work with, who we go deep within our partnerships, is evolving,” Bradbury said. “It needs to create value, not for us, but for the patient and their family who we try to serve, and create more value for the entities that are at risk.”

In order for conveners to survive in today’s market — especially as value-based arrangements become more of the norm — they have to make both the payer and provider better off financially.

“A convener that’s going to become an enabler has to make the payer better off in terms of taking risk and delivering something on its behalf,” Greenstein said. “For the providers, we need a rate opportunity for it to be better. A good enabler will go in and interrogate the data to see if their PMPM spend on home care is at least in the ballpark. In many cases, it’s going to be too low and the rates need to be increased and the total spend needs to be increased.”

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As such, health plans and other stakeholders are increasingly considering what it takes to make the home a more effective site of care. Many are finding that home care benefits management is key.

At BlueCross BlueShield of South Carolina, Integrated Home Care Services (IHCS) serves as the home care benefit administrator.

“Having a relationship with someone like Integrated Home Care Services is extremely important and valuable,” Kat Gesh-Wilson, vice president of Medicare Advantage at BlueCross BlueShield of South Carolina, said on Thursday during a HLTH webinar. “It’s valuable because they can be the eyes and ears of the [health] plan, to understand what’s going on in the home.”

Indeed, IHCS is a driver of value-based care, through durable medical equipment, home health care and home infusion management. The company serves managed care plans and its members. Its model streamlines hospital discharges and care coordination.

On its end, BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.

Reducing the administrative burden of its health plan partners is one of IHCS’ main goals.

“We work through any sort of challenges and come up with new and innovative ways to be able to service the members,” Paul Pino, chief development and analytics officer at IHCS, said during the panel discussion. “With Kat and her team, we’ve developed patient opportunities around palliative care, but we’ve also developed opportunities around personal care and other items that people tend to not necessarily focus on.”

Gesh-Wilson believes that her organization’s relationship with IHCS is essential in delivering good health outcomes for BlueCross BlueShield of South Carolina’s members.

“From our standpoint, to be aligned means to have the same goals in mind, not to create unnecessarily high utilization solely for the purpose of being reimbursed more money,” Pino said. “For us, it’s really about managing the patient, meeting medical necessity, and improving outcomes. When we align ourselves financially with a payer, we’re both really looking at what’s best for the member, and not necessarily always what’s best for our pockets.”

Under the partnership, one of the areas IHCS is focused on is emergency department (ED) diversion.

“The biggest reason why someone’s presenting into the ED stems from the fact that resources are not available,” Pino said. “There is a limited resource, or limited number of people within a plan setting that truly have home care-oriented expertise. For us, we can go into the network community, we can go wide, and we can go large, to make sure that someone sees that patient immediately.”

IHCS has also formed strong connections with BlueCross BlueShield of South Carolina’s medical management staff.

What makes the partnership work, the two sides believe, is strong local relationships.

“Someone who tries to go in and manage an opportunity by throwing a slew of national, large network-oriented providers at a plan is never going to be successful,” Pino said.

Looking ahead, Gesh-Wilson is looking to form relationships with partners that are eager to take on risk.

“I need partners in my world who are willing to go at risk just like I am,” she said. “This sounds a little cavalier, but if they’re as good as they say they are, then they’ll go at risk.”

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Poor communication and coordination among various stakeholders, delayed services and lower member satisfaction are just a few of the challenges facing home care implementation from health plans.

The survey, published by Integrated Home Care Services (IHCS) and Sage Growth Partners, includes the responses from 47 health plan leaders. Some of the findings left IHCS leaders puzzled.

“About 72% of respondents say that strategic drivers were a main reason why care is starting to move to the home, yet two-thirds say they rarely meet and discuss this care,” Paul Pino, chief development and analytics officer at IHCS, told Home Health Care News. “These two are almost diametrically opposed to one another. There’s a disconnect there that really has made us scratch our heads.”

Integrated Home Care Services delivers home-based care to over 2.2 million patients through partnerships with health plans and risk-bearing provider organizations.

The company is an independent home care benefits administrator that offers a value-based home care model for managed care organizations.

While Pino is encouraged that health plan executives recognize the growing demand for home care, there is still a lot to be done when it comes to dedicating time and resources to home care.

Over the past five years, 91% of the health plan executives in the survey said that home care service utilization has increased.

However, a majority (60%) said they support members’ use of home care “moderately well.”

If those executives know demand is there, it would be a more relevant conversation, Pino continued. About the same number of executives, nearly two-thirds, said they rarely talk about home care.

“You would anticipate that if they rarely meet to talk about it, they probably don’t have an opinion as it relates to home care,” Pino said. “But they know that it’s a problem, it just hasn’t been a focus.”

Pino believes that the COVID-19 pandemic has something to do with that. Health plan executives have been so focused and engaged with some of the institutional-based components of care that home-based care has not been top of mind, he said.

Health plan executives also have recognized that costs have gone up for home care: 96% of respondents indicated that home care costs have increased over the past five years. Of those, over 25% said costs have increased more than 10%.

That trend might continue for the next few years.

“There is an understanding right now within health care that there’s only so much you could squeeze,” Pino said. “You’re not going to get a significant amount of profitability from over-squeezing the lowest cost provider. If you look at any sort of utilization-oriented trend, and you start looking at total cost per patient and when you compare home care to SNF, SNF typically has 200% the level of reimbursement, on an average per patient basis, than home care would.”

Home health and home care should see slight upticks in costs, Pino said, especially when it comes to managed care.

Home care strategy and optimization continue to be hurdles for these executives as well. Of the 47 executives surveyed, only 36% said they are “very proficient” at assessing home care’s impact on total costs.

These results, although surprising in some ways, were also validating for companies like IHCS who can help bridge the gap between health plans and home-based care.

“The trends that we’re seeing, not only from a utilization perspective but from a cost perspective, continue to rise,” Josh Holmes, senior vice president of business development at IHCS, told HHCN. “The opportunity for a home care benefit and administrator to collaborate with these populations, on behalf of a health plan, couldn’t be better.”

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Integrated Home Care Services Inc. has named Christopher Bradbury as the company’s new CEO.

Bradbury succeeds Jorge Pereda, who has served as CEO since the company’s inception. Pereda will now serve as chairman of the board.

“After building successful companies throughout the last 30 years, I am excited to use my experience in a fully strategic capacity within IHCS,” Pereda said in a press statement. “For nearly a year, we had been searching for a dynamic leader to pass the CEO baton to and I could not be happier that we found Chris. His experience and proven track record of delivering better outcomes for patients, providers, and health plans will further position IHCS to take that next step forward and unlock our potential to serve customers on a national level.”

Indeed, the appointment comes on the heels of Integrated Home Care Services’ national expansion efforts.

Currently, Integrated Home Care Services delivers home-based care to over 2.2 million patients through partnerships with health plans and risk-bearing provider organizations. By 2023, the company expects to serve over 3 million patients through value-based models.

The company is an independent home care benefits administrator that offers a value-based, fully integrated home care model for managed care organizations.

Bradbury steps into the CEO role with experience accelerating the growth of companies.

Before joining Integrated Home Care Services, Bradbury was vice president at CVS Health (NYSE: CVS). He led Aetna’s commercial solutions and portfolio of specialty businesses.

“IHCS’ approach has helped health plans enhance their home care services by improving clinical outcomes, lowering medical costs, enabling more actionable data insights, and accelerating their strategies to make health care easier,” Bradbury said in a statement. “I’m excited to bring these benefits to more plans and patients across the country.”

Honor adds new CFO

Andrew Steinberg has joined the technology-enabled home care startup Honor as chief financial officer.

“I am thrilled to welcome Andrew with his deep breadth of knowledge to our executive leadership team,” Seth Sternberg, co-founder and CEO of Honor, said in a press statement. “His alignment with Honor’s mission to expand the world’s capacity to care will position us to optimize the massive opportunities we are experiencing in the home care market and enhance our ability to deliver on this vision.”

As CFO, Steinberg will lead the company’s financial strategy, drive growth and open the door for new opportunities.

Prior to joining Honor, Steinberg was managing director with a focus on M&A at Evercore. Before that, he worked in a global strategy role at Google (Nasdaq: GOOGL).

“It’s not every day that you get to support an industry disruptor through its continued expansion,” Steinberg said in a statement. “Honor is leading the industry by bringing technology-driven, quality care to older adults around the world, and I am excited to further solidify Honor as the key innovator in the home care market.”

Honeybee Homecare appoints COO

Honeybee Homecare has promoted Timothy Bush to chief operating officer.

“I am thrilled to extend my passion and vision into the home care division of senior care as we grow this brand in new markets while providing quality senior care in their home environment,” Bush said in a press statement.

Roswell, Georgia-based Honeybee Homecare is a home-based care organization that delivers housekeeping, medication management, assistance with activities of daily living and companionship for seniors.

Prior to joining Honeybee Homecare, Bush was COO and executive vice president of Phoenix Senior Living.

In his new role as COO, Bush will oversee daily operations and carry out the strategic direction of the brand.

Forcura promotes SVP to CFO

Forcura has promoted Jason Schoepfer to chief financial officer. Prior to this, he served as senior vice president of finance.

Schoepfer officially joined Forcura in 2018, but has been involved with Forcura as a consultant since the company’s inception.

“Jason has been a part of Forcura from our earliest days, and I can’t stress enough how his leadership and acumen have shaped the trajectory of the company,” Craig Mandeville, founder and CEO of Forcura, said in a statement. “Not only did Jason deftly manage our first-ever equity partnership with Accel-KKR in 2020, but he has also hired and mentored a world-class finance team which positions us for more incredible growth. We look forward to him helping lead us into our next chapter.”

Jacksonville, Florida-based Forcura is a health care technology company that helps post-acute providers with streamlining workflow and documentation management.

In his new role as CFO, Schoepfer will oversee all of Forcura’s finance, accounting and legal functions. He will also be responsible for financial planning and risk management.

Former CMMI official joins ATI Advisory

Bill Winfrey has been appointed director of ATI Advisory. He will be part of the Medicare Innovation team.

ATI Advisory is a Washington, D.C.-based research and consultant firm that aids both businesses and government leaders.

Before joining ATI Advisory, Winfrey spent seven years at the Center for Medicare and Medicaid Innovation (CMMI). His most recent role at CMMI was as a social sciences research analyst.

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Home Health Care News: Paul, what career experiences led you to co-found Integrated Home Care Services?

Paul Pino: In 2007, I joined and invested in the predecessor to IHCS, a company created by our CEO in 1993 whose model coordinated durable medical equipment (DME), home health and home infusion under a capitated payment methodology. We sold that company in 2012, and in 2015 we re-entered the market as IHCS after we received an outpouring of requests from prior payer partners who needed a home care partner that was willing to manage utilization, create and manage networks and adjudicate claims under a risk-based methodology.

Based upon this request, we created a technology-enabled and fully transparent model that is accountable for coordinating all facets of home care services through a delegated, high quality, patient-focused approach.

What are the top challenges in the home-based care space that the IHCS model seeks to address?

Pino: When it comes to the IHCS model, our contracting approach and service standards start with a patient-centered focus and work backwards from there. As I speak, we’re seeing the largest ever increase in homebound seniors. Over the course of the pandemic, we’ve seen a two-and-a-half times increase in the number of homebound seniors over the age of 70, from just below two million seniors to over 4.4 million.

This vulnerable population needs a range of care options, from the very basic services, such as bathing and washing, to high-acuity level services. An example of this would be someone who’s been discharged from a hospital with a wound. We would not only have to coordinate the home infusion medication, the nurse who administers the infusion, and the hospital bed with an air-fluidized mattress, but also provide support if the patient needs help getting out of the bed or into the bathtub.

These additional routine yet necessary functions require coordination, and could be the difference between home-based and institutionally-based convalescence and costs.

What are the top key features in the IHCS model that help solve those top challenges that you just laid out?

Pino: We are both service-type and line-of-business agnostic. Ultimately, we were created to meet all the home care needs of our managed care partners. There are other home care administrator models that focus on Medicare Advantage (MA) and potentially commercial books of business. At IHCS, we not only have deep experience in servicing the MA and commercial populations, but we also have extensive resources focused on the managed Medicaid population.

As a result, we provide all managed care payers and patients delegated administrative services — including coordinating unskilled services such as companion care, attendant care, respite and other services — that members require. We don’t limit ourselves to coordinating highly acute, highly specialized needs. We are a single point-of-care coordinator for all home care needs.

Also, because we see a significant correlation of home care service-types — 20% of DME patients may require home health, 50% of home health patients require DME and 80% and 50% of home infusion patients require home health and DME, respectively — our model offers all of the home care verticals needed for all patients at all times.

What are the most exciting outcomes and anecdotes that reveal how the IHCS model has helped patients, payers and providers?

Pino: The most exciting outcomes are always patient-centered. Across the board, our plan partners will tell you that we have increased patient satisfaction and generated significant applause from patients in terms of having a single partner that can coordinate the entire grouping of home care entities that will be visiting their home.

We have also seen improved health outcomes as measured by correlated, institutional-based metrics, such as average lengths of stay, ER visits and readmits per thousand. A key measurement of our success is the significant reductions we’ve delivered in terms of transfers from emergency rooms to the inpatient setting versus the home setting. These patients now have the resources necessary to convalesce in the home setting.

The reason for these institutional reductions is our ability to staff cases and staff them quickly. We coordinate care as a partner with our patients and providers in mind. As a result of this partnership, we’re able to make a significant impact in the areas where both patients and providers feel the greatest pain point: scheduling and coordinating. There are a significant number of providers and patients that would rather work with IHCS than with health plans because we focus specifically on home care.

Historically, home care is a core grouping of services that only make up four to five percent of a health plan’s spend. Large health plans aren’t necessarily built to manage smaller cost relationships and services. For us, our network participants are the engine that drives our operations and help meet our plan commitments. When it comes to the manner in which we treat, pay and communicate with our downstream providers, you’ll find that we consider them and our employees our greatest assets.

You’ve called the IHCS model “the future of health care.” Why do you view it that way, and how can health providers succeed in value-based systems?

Pino: “The future of health care” is always a tricky statement because we know that health care is an ever-evolving organism. We believe the future is one that allows people to convalesce in a manner that makes the most amount of sense, not only for the patient but also for other stakeholders such as plans and risk-groups that are held accountable for patient care and costs.

Ultimately, as you think about the future, you can see health plans reduce resources surrounding areas that will not create a large enough cost delta from where current practices are to where future practices could be. If you seek to focus a plan’s utilization management on saving significant dollars by maximizing patient outcomes, you’re not necessarily going to focus on home care, but rather on institutional-based spend, pharmacy, specialists and other associated modalities of care that require a heavy focus on fewer, but costlier items.

Our model takes the approach that we professionally handle the tasks that plans don’t have the time or resources to completely manage. We have risk-based, capitated contracts. As a result of this reimbursement, we have extensive performance and service guarantees we provide our plan partners.

Because quality is inherent to every one of our contracts, we’ve been tied to all aspects of health care quality and value-based contracting that have been around for decades. However, these quality metrics are just beginning to be considered by traditional fee-for-service market participants. As a result of our significant quality and audit infrastructure, our plan partners continually monitor our performance and results through our proprietary patient management platform, MedTrac.

Medtrac is an industry-leading and partner-facing system that captures all salient patient, authorization and provider data. This technology is readily and transparently accessed by our plan partners for multiple purposes including monitoring members and contractual guarantees.

Furthermore, our ability to garner, analyze and share sophisticated and massive data sets with our plan partners is key. Rather than dealing with sporadic data streams, we provide a single, consistent and customizable data relay in real time. Plans use this data to make significant decisions and research patient needs. Our ability to trace and track utilization cohorts is significant for health plan finance and case management units.

The future requires sophisticated quality- and data-oriented market participants. More services will go to providers that are fully engaged in whole-person, quality-oriented relationships rather than payment-oriented relationships. Every effort we are leading right now, in essence, will be what all other home care models will follow in the future.

What is upcoming for IHCS over the next year?

Pino: We have a couple of things that are really exciting. One, we’re going to be launching in an additional 12 states on January 1, 2023, with key managed care partners that have seen the impact and value of our model. They are expanding with us into multiple geographies throughout the country.

Currently, we manage about 2.2 million lives. Of those 2.2 million lives, about 60% are managed Medicaid lives, less than 5% are commercial and approximately 35% are Medicare Advantage. We see that membership complexion changing a bit as we expand into additional commercial and MA plans rolling forward towards over three million lives in 2023.

We are also expanding our model to go beyond our core service offerings of home health, home infusion, and medical equipment. We’ve started to consider relationships with companies that are heavily engaged in primary care services rendered within the home. We have also focused on building relationships with home-based providers of companion-oriented services. We are also focused on gathering and democratizing socially-oriented data from the home.

Finish this sentence, the home based care industry in 2022 will be the year of…?

Pino: 2022 will be the year of home-based care transformation. With the recent announcement of potential home health reimbursement rate cuts, many providers are looking at offsetting some of what we’re seeing from a payment standpoint by transforming their models.

I think it’s off-putting that a large component of why we are seeing any sort of rate decrease from CMS right now in Medicare fee-for-service comes from a behavioral assumption element. To combat this reduction and prove out the need for upward adjustments in reimbursement, providers need to move from a P&L-oriented approach in management to a data-driven approach.

Sharing more and cleaner information with regulators and government payers such as Medicare will help demonstrate that the home is indeed the most cost-effective and desirable site of care for patients.

​​Editor’s note: This interview has been edited for length and clarity.

Integrated Home Care Services (IHCS), the nation’s leading independent home care benefits administrator, offers a value-based, fully integrated home care model for managed care organizations, with a unique model that improves care quality and coordination while reducing administrative costs by managing key functions such as network development, management, credentialing, utilization management and claims. To learn more, visit IHCScorp.com.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com.

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