BCBS Exec: ‘I Need Partners Who Are Willing To Go At Risk’

Despite the high demand for it, home-based care isn’t always well managed or coordinated. Consequently, this can lead to increased costs and lower-quality outcomes for health plans.

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.”