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Home-based care leaders are gaining some gusto. They are at the helm of the organizations that should, theoretically, be the beneficiaries of an overload of demand over the next decade.
In the past, providers have pleaded for a “seat at the table” in the health care continuum. But, to a certain extent, they now hold the cards.
That may not always be evident, particularly in conversations with Medicare Advantage (MA) plans and the Centers for Medicare & Medicaid Services (CMS).
But with the right tools and strategy, providers have the leverage to potentially change the course of those conversations, and also vouch for themselves on much higher ground.
“I think all of us would love to see this industry mature and take hold of the advantage that we’re creating for the U.S. health care system and for Medicare Advantage payers,” Compassus CEO Michael Asselta told me on stage Thursday at Home Health Care News’ FUTURE conference in Nashville. “But there’s a maturation that we all have to undergo to capture that opportunity.”
What home health providers need to do to mature, and what that maturation could lead to, is the topic of this week’s exclusive, members-only HHCN+ Update.
A maturing industry
On the first panel of the FUTURE conference Thursday, the home health leaders on stage stripped themselves of the woe-is-me mentality that can sometimes hamstring the industry.
Asselta – who is relatively new to the industry, having joined Compassus in May – acknowledged the gap between providers and the significant opportunities that could be waiting for them in the near- to long-term future.
One of the first recommendations that he had was building out what he called “wraparound services” in addition to home health care.
“These recurring hospital visits are very expensive,” Asselta said. “Managed care understands this already, and they’re willing to reimburse us. So we have to ask. We have to build and ask. We have to weave things together a little differently for traditional Medicare, and that is providing reimbursable services under our umbrella. That means expanding, it means growing up quite a bit, and that’s sort of a theme we’ve heard, too.”
Based in Brentwood, Tennessee, Compassus provides home health care, home infusion, palliative care and hospice care. It has about 7,000 team members and more than 270 “touch points” across 30 states.
Outside of wraparound services, Axxess CEO John Olajide acknowledged the need for providers to collect and utilize data in a more practical manner.
“You cannot accomplish what you want with the payers – or whoever the stakeholder is – if you don’t have data. And to have data, you need to have the right technology,” Olajide also said on stage. “If there’s not a large data set, there’s not a lot of information to leverage in [those conversations].”
Founded in 2007 and based in Dallas, Axxess is a home health technology company.
Gentiva CEO David Causby offered up an example.
The company’s home-based palliative care business can take a payer’s most at-risk patients, which readmit to the hospital at a 30% clip, and get that number down below 10%, Causby said.
That ability, plus the data, creates leverage.
“For the industry to continue to move forward, … I think you have to scale companies,” Causby also said on stage. “You’ve got to be sophisticated. You’ve got to have a playbook on effective and efficient operations. You’ve got to be innovative. You’ve got to have data.”
Based in Atlanta, Georgia, Gentiva provides palliative care, hospice care and other home-based care services via about 600 locations across 38 states.
“You’ve got to stop being the downstream, waiting for the phone to ring,” Causby continued. “Move up, and truly show the value add. There’s no doubt, over the next 30 to 50 years, this will be the fastest-growing sector in the health care space. For those that are willing to get out there, get after it, do it the right way, be very fundamentally sound in how you operate and take the lead on innovation, technology and analytics – those are the people that will be successful in this space.”
Home-based care providers are in the right business, the right setting. But that alone won’t be enough.
Providers across the home-based care continuum need to take the next step.
“We need to continue to press for a discussion around what leverage we’re bringing to the managed care payer,” Asselta said. “Can we collectively, as an industry, start to say, ‘Hey, look, if I deliver X results, you can hold me accountable for Y. And I don’t know if we’re going to be able to change the narrative until we’re unwilling to take rates that don’t reflect the value that we provide.”
