In a best-case scenario, conveners have the ability to form beneficial partnerships with home health providers.
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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