The need for a new ICD-10 code for sepsis survivors was spurred by findings from a VNS Health study showing that sepsis was noted in admission assessments only 7% of the time. This caused researchers to question whether home health providers were aware that a patient had been diagnosed with sepsis. The study also identified the risk factors associated with early readmission of sepsis survivors.

“Having an ICD-10 code for sepsis aftercare lets providers know when a patient discharged to them is a sepsis survivor,” Dr. Kathryn H. Bowles, director of the VNS Health Center for Home Care Policy & Research, told Home Health Care News. “When people are hospitalized for sepsis, they are not discharged until the illness is resolved. When sepsis is resolved, it falls to the patient’s history and may not be included in the current problem list communicated during the transition to post-acute care.”

VNS Health provides home, hospice, and personal and private care services in New York. The Center for Home Care Policy & Research conducts research to support home- and community-based services and inform decision-making providers, policymakers and consumers.

“Because sepsis has a high readmission rate mainly due to recurrence, any patient who has had sepsis is at risk, and many suffer a long recovery dealing with the after-effects of sepsis,” Bowles continued. “Research showed timely attention the first week after sepsis discharge effectively decreases 30-day readmissions. If the next level of care doesn’t know the patient is a sepsis survivor, providers cannot activate effective protocols for prevention. The new code will alert the next level of care.”

An ongoing study by the same research team revealed the lack of a diagnostic code to identify sepsis survivors after discharge. Home health personnel explained that because sepsis is an acute care condition treated and resolved in the hospital, they cannot place it on the home care record. The study provided evidence that because of this communication gap, home care providers and clinicians may not be prompted to give the attention and close monitoring that sepsis recovery warrants.

“As our team discovered, there was a serious communication gap between hospitals and post-acute care providers when it came to caring for sepsis survivors,” Bowles said. “Without knowing an incoming patient had recently survived sepsis, home care providers were missing an important piece of the puzzle in determining a plan of care. Because there was no aftercare code, sepsis survivors were being coded as having pneumonia or urinary tract infection, or ‘other aftercare.’ However, as we know, knowledge is power, and with this code, home care teams and patients are empowered. They can provide the necessary care to avoid a recurrence of sepsis and preventable hospitalizations or death.”

Following the publication of these findings, the research team led an advocacy effort to persuade the CDC to adopt a diagnostic code defining sepsis aftercare as a separate condition. The new code was accepted and announced in July and took effect Oct. 1.

“Knowing the patient is a sepsis survivor alerts the team to activate evidence-based protocols for timely start of care and outpatient follow-up, close surveillance, antibiotic stewardship and patient teaching,” Bowels explained. “Sepsis strikes fast, so patients and caregivers must be educated to monitor their temperature, take their medications as prescribed and call their home care providers immediately if they feel worse.”

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As one of these next generation leaders, RJ Gagnon is making a name for himself at Andwell, but it doesn’t end with him. The company has already set its sights on developing the next set of future leaders.

“Our organization has really focused on development of leadership,” Gagnon said Monday during a panel discussion at the National Association for Home Care & Hospice’s (NAHC) Financial Management Conference. “When we look at our budgets, sometimes that’s one of the things that’s first cut. That’s something we need to invest in.”

Formerly Androscoggin Home Healthcare + Hospice, Andwell is a nonprofit operator that offers home health, hospice, palliative, behavioral health and pediatric care services. The company employs over 500 workers across all 16 counties in Maine.

Along with cultivating the next crop of leaders, companies are figuring out how best to work with a multi-generational workforce.

Currently, UVA Continuum Home Health has four different generations that make up the organization’s staff. Catherine Harris, the home health director at UVA Continuum Home Health, has learned to accommodate individuals based on what stage they’re at in life.

This also gave Harris the opportunity to listen and learn from her more experienced colleagues.

“When you think generationally, you’re really thinking about where that person is in life,” she said during the discussion. “My younger partners are just starting to have kids. They’re taking leave, [it’s about] giving space for that, and celebrating that, versus the generation before us, the baby boomers … who are preparing to retire. Am I listening to them? Am I focused on the lessons that they’ve learned? Because if we’ve learned nothing, it’s that history constantly repeating itself.”

UVA Continuum Home Health is an academic home health agency associated with the University of Virginia in Charlottesville. The organization serves several cities across the state.

Matt Chadwick, CFO of Well Care Health, stressed the importance of not bringing preconceived notions to the workforce when working with multiple generations.

“It’s about, [for example], not going in with the perception that a younger person might know technology better than the older person, but listening to their concerns, hearing what their skill sets are and really trying to find the right space for them,” he said.

Well Care Health is a Wilmington, North Carolina-based provider of home health and hospice services. The company serves more than 4,000 patients, and employs more than 600 employees. It operates across 40 counties in North Carolina and South Carolina.

Chadwick noted that it has been important for Well Care Health to make sure they are placing people in the roles where they’ll succeed the most.

At VNS Health, leaders began to notice a higher turnover among younger nurses. The company sought to address this by establishing a nursing grad program six years ago that emphasized mentorship.

“They’re learning about home care,” Sarani Doshi, vice president of corporate financial planning and analysis at VNS Health, said. “They’re getting their feet wet and taking care of patients in the homes for real now, and we’re giving them the tools they need to be successful, to grow and develop in the way that they’d like to.”

New York-based VNS Health is a full-service home-based care organization. The company has almost 40,000 daily patients.

VNS Health has seen less turnover among younger nurses after the implementation of the program.

Additionally, the company has begun developing closer partnerships with New York area nursing schools, according to Doshi.

“We’re spending a little bit more time in the school, educating students around home care, the value of home care and the benefits of home care, and providing scholarships to students who are showing interest in coming into home care post-graduation,” she said. “That, coupled with our nursing graduate program, has started to gain some traction, and we’re seeing some of that affect turnover and retention.”

Ultimately, Gagnon believes that it’s imperative to set employees up for success by taking professional development seriously.

“We need to let the teams know that they matter,” he said. “We have management meetings where the first half is business as usual. The second half is very direct leadership development with strategies where we bring in facilitators. We are investing in that team. That lets them know, ‘We want you to be successful.’ Our No. 1 job is for our team to be successful.”

The post How Home-Based Care’s Leaders Foster A Multi-Generational Workforce appeared first on Home Health Care News.

Broadly, home health deserts are low-income communities that are the hardest to staff and where people who need home health care are unable to access it. A home health desert can be a rural or urban area, according to Dan Savitt, president and CEO of VNS Health.

VNS Health is one of the home health providers that has been at the forefront of the movement to bring quality care to home health deserts. Bayada Home Health Care is another provider working toward this mission.

Savitt explained that patients who don’t receive care in the home often end up experiencing more issues down the line.

“Patients who are referred to home health and receive it within seven days are far less likely to end up back in the hospital, and they have lower mortality rates than those who don’t get home health,” he said during a recent Home Health Care News webinar. “The fact that the system can’t support it today means that it’s costing the nation more.”

Savitt also noted that communities that are predominantly made up of racial and ethnic minorities are more likely to be home health deserts.

“Lack of access happens to be in racial and ethnic minority neighborhoods,” he said. “They are much less likely to get that care they need within seven days. They’re much more likely, and we’re seeing this in our communities, to end back in the hospital. Then they are at greater risk.”

A University of Michigan study recently found that nurses are less likely to give Black patients, compared to white patients, referrals to home health when being discharged from the hospital.

Watch: 2024 Home Health Outlook webinar (click)

In fact, the study found that about 22% of Black patients were receiving home health referrals by discharge nurses, compared to 27% of white patients.

The South Bronx is one of the home health deserts VNS Health is working to address.

“There are a million people in the Bronx, so it’s not a small surface area,” Savitt said. “It’s bad enough that, overall, in New York City only 50% of the referrals are getting admitted into home health — it’s less than a third in the Bronx.”

Addresing home health deserts means additional costs for providers.

“North Philadelphia is a tough area to cover, so is rural Vermont, very different geographies, but with similar challenges,” Michael Johnson, practice president for home health at Bayada, said during the webinar. “Those costs are not included in any reimbursement.”

Due to this, VNS Health is advocating for MedPAC and the Centers for Medicare & Medicaid Services (CMS) to measure access and capacity based on the ability to take on admissions, and not based on the number of agencies in the area.

“MedPAC and CMS measure access to home health services based on the number of beneficiaries living in a zip code by one, or more agencies,” Savitt said. “If there’s one more agency in a zip code, check the box from a CMS and MedPAC standpoint. That has to change.”

Savitt also called for Congress, MedPAC and CMS to get a better understanding of the home health desert crisis from the patient perspective.

“I spent enough time in D.C. to know that the people making and setting policy don’t understand the work that we all do every day,” he said.

Johnson pointed out the importance of payer advocacy outside of CMS, as well.

“I do believe that enlightened payers want to take care of their communities,” he said. “We actually have more in common with payers, in terms of keeping a population of people healthy. How do we build partnerships, because that is a big factor in terms of access.”

The post Home Health Providers Are Tackling ‘Home Health Deserts,’ Calling On CMS To Help appeared first on Home Health Care News.

In 2024, however, providers can win with the correct focuses in mind.

“You don’t want a managed care strategy; you want a value-based care strategy,” Anne Tumlinson, founder and CEO of ATI Advisory, said during Aging Media Network’s Continuum conference. “Managed care is just a financial tool — much like how population-based health demonstration programs like ACOs are financial tools.”

The Washington, D.C.-based ATI Advisory is a health care research and advisory services firm.

Changing the way a home health agency operates is no easy task. In fact, it’s a huge operational shift that Tumlinson has seen firsthand.

“To move from delivering units of service to delivering value is really, really difficult,” she said. “Changing what it is that you sell and how you get paid to do it is a huge undertaking.”

That’s a road Devin Woodley, the VP of managed care contracting with VNS Health, is very familiar with.

New York-based VNS Health is one of the largest nonprofit home-based care organizations in the U.S. It offers home health, hospice, palliative care and mental health support services, among others. It also has its own health plan.

At VNS Health, as the market has changed, Woodley and his staff have focused on marrying what capabilities the agency has to market opportunities.

It also helps that VNS Health is a “payvider.”

“Working with our health plan, we understand how to take on risk from a large health plan perspective and what health plans’ pain points are,” Woodley said. “From the provider side, we also have a deep understanding of how to take on risk. Now we’re able to bundle that together on the payvider model and figure out where the synergies are between the two sides.”

For agencies who might not be as adept at working with a health plan, Tumlinson said there are a few key points to focus on.

The first is to make sure the clinical model is built for value.

“Do you have a clinical model that can actually deliver outcomes as opposed to just units of service?” she said. “Do you have some kind of a mechanism for aligning payment for those clinical services in a way that rewards you for that value? Whether it’s an ACO contract or a managed care contract, or contract with somebody who’s doing that.”

The second key ingredient is the room for scale.

“Even if you’re not a real estate-based provider like senior living, and you’re an operator that delivers more of a continuum of care in the community, there are lots of ways in which you can attach yourself to scale,” Tumlinson said. “Partnering with senior living is one of them. So you have to have those three pieces: a clinical model, the financial alignment through contracts and the scale.”

Self-awareness plays a key role in surviving and thriving in today’s market as well.

For VNS Health, there’s an obvious benefit of having its own health plan, but understanding the ins and outs of the health plan helps Woodley and his staff make the most of its partnerships and opportunities.

“We intimately understand — in owning our own health plan — what those silos are that health plans have,” Woodley said. “There’s a lot of grain that falls between those silos and there’s a lot of good eating we can get out of that grain that’s falling between them. Being able to leverage that understanding with our capabilities, matching that up, that’s how we’ve been able to unlock some really good value.”

The post ‘You Want A Value-Based Care Strategy’: Tips For Home Health Providers In A Managed Care World appeared first on Home Health Care News.

At Bayada Home Health Care, these priorities include focusing on the employee experience, as well as clinical-model evolution.

“How do we take what we learned to be successful with PDGM and transition that to being successful with TPS, and to some degree transition that to be successful with MA expansion given the limitations,” Michael Johnson, practice president for home health at Bayada, said during a recent Home Health Care News webinar. “We’re working on how to continue to be relevant even though there’s payer pressure.”

Watch (click here): 2024 Home Health Outlook webinar

Like Bayada, the employee experience is also top of mind at VNS Health.

Dan Savitt, president and CEO of the company, described retention improvement efforts as “critical.”

“How do we, as an organization, become that employer of choice for any field clinician who wants to work in home- and community-based care,” he said during the webinar. “That’s not an easy nut to crack, so we’re continuing to focus on that.”

The other side of staffing is recruitment. One way that VNS Health is widening its talent pool is by partnering with nursing schools.

“Many of us partner with nursing schools; it’s the right thing to do,” Savitt said. “We have created a new partnership, which we’re excited about. As nurses roll through their program, they can specialize in home health. We delivered the curriculum over the last year and gave them new experiences in the field, so that we have better success with new grads.”

In general, a lot of VNS Health’s retention efforts with new hires is about zeroing-in on that first 12 to 18 months. Savitt pointed out that once an employee reaches the two-year mark, the likelihood of retention increases.

Additionally, VNS Health is also focused on things like optimizing the company’s clinical resources to expand capacity, becoming a differentiated market leader in patient experience and quality outcome and admin efficiency, according to Savitt.

On its end, Bayada implemented a nurse residency program. The company has been able to achieve a 97% renewal rate for nurses that come through the program, according to Johnson.

Working with the company’s EMR partner to reduce the documentation burden that field clinicians face is another important area of focus.

“How do we do things that help people spend more time with people,” Johnson said. “Home care is the most onerous documentation environment I’ve ever worked in. That’s part of the reason good clinicians leave. They’re spending time with their tablet, not with the patient. Five minutes more on the tablet, five minutes less with the patient.”

Companies like CareXM — a triage technology platform — have been front and center when it comes to helping home health organizations rebalance their nursing workload.

“We focus on three areas — after-hours triage, care coordination, and a sense of proactive patient engagement,” CareXM CEO Si Luo said during the webinar. “We typically engage with customers to assess their current staffing structure related to those areas, and attempt to characterize, ‘What does the overall workload look like, today, for each team at different time intervals?’ We often spot opportunities, together, to apply coordination and workflow technologies that help home health organizations run much leaner in these areas while achieving a greater surface area of impact and engagement.”

For many home health providers, keeping an eye on how the payer landscape is shaping up in 2024 will also be crucial to their businesses.

On its end, VNS Health has found the managed care landscape to be a challenge.

“We have a little bit of a unique opportunity in New York, because we have such a big market share, we ultimately had to use termination as a method by which to really get people to the table,” Savitt said.

Savitt also noted that the administrative burden of managing payer contract requirements has become unsustainable for providers.

“For every managed care organization, I typically have two or three relationships, one with commercial, one with Medicaid, and one with Medicare,” he said. “Multiply the number of managed care organizations by all their business lines, you’re talking about 15 to 20 relationships and administrative complexities. The no managed care, less managed care for organizations is going to be a lever that the industry will continue to pull because we really don’t have a lot of other levers at this point.”

Bayada recently signed a contract with a large regional national payer.

Ultimately, Johnson believes that for providers that can handle uncertainty and ambiguity, now is the best time to be working in health care.

“That’s the only time things change,” he said. “You can complain about it, or you can lean in. I think there are payers now, particularly with the movement towards payer-providers, like a Humana or Optum, there are other payers that are interested in saying, ‘Hey, how can we start to get more creative?’”

The post ‘You Can Complain About It, Or Lean In’: Top Home Health Leaders Brace For 2024 appeared first on Home Health Care News.

Home Health Care News recently spoke with 15 home-based care leaders for our annual “Executive Forecast” articles, which we published at the end of last year.

Those executives’ responses covered a wide range of topics, and were surprisingly and refreshingly diverse. But, in the end, a few themes emerged.

In part, these answers helped form our home care and home health trend predictions, released last week and this week, respectively.

But the specific executive perspectives are worth revisiting.

In this week’s exclusive, members-only HHCN+ Update, I analyze the executive outlooks and offer key takeaways, including:

– An impending upheaval of the traditional home health business model

– The supply and demand labor issue

– An Increase in efforts related to AI and other future-facing technologies

Coming to grips with Medicare Advantage penetration

In HHCN’s home health trends piece, we wrote about the evaporating home health fee-for-service business model.

Even Amedisys Inc. (Nasdaq: AMED), which is likely to be a part of one of the largest payer organizations in the country soon, is adjusting operations with Medicare Advantage (MA) in mind.

Amedisys CEO Richard Ashworth is particularly focused on his company – and the industry at large – coming to the table with better data to demonstrate value in 2024.

“Data and analytics to drive the value proposition will be an important focus for 2024,” he told HHCN. “It will be essential that the industry has the data and outcomes to show the broader value impact — in addition to capacity, home health provides a more positive patient experience with lower costs.”

Ashworth sees data and analytics as integral to negotiations with payers. But he also believes that home health providers can boost their value by coordinating care, or being a liaison to other services such as personal care, housekeeping and rides, among others.

“I see home health as a huge driver of cost savings as well as offering better quality of life and outcomes for patients in 2024,” he said. “The need to convey that to the payer community and the government is important. We should drive for efficiency as a challenge in 2024, but also to unlock opportunity.”

New Day Healthcare CEO G. Scott Herman, who is running one of the more quickly growing home health providers in the country, believes that home health providers are considerably behind in adjusting to take care of a home health population that is skewing more and more toward MA over traditional Medicare.

It’s one of the reasons New Day is operating a remote home health model in Texas.

The visits are in person, but the company does not have brick-and-mortar locations tied to a certain area. That is in order to keep overhead costs down.

“What our company is doing is, we’re focused on understanding exactly how those Medicare Advantage payers work, building models that support them that are remote and that are driven with data and analytics through our ‘Carelytics’ system,” Herman told HHCN. “Models where we can sit down and understand how to work with patients longitudinally, do cross referrals internally and then take the business that those payers really need to take in markets where they’re struggling with providers.”

Home health leaders may not agree on the best way to achieve sustainability in a world more dominated by MA. But they are reaching a near-consensus on the fact that providers do need to adjust operations to survive, and that continued MA penetration is both a threat and a reality.

“2024 is the year for tomorrow’s home care provider to build plans on how to thrive — not just survive — with Medicare Advantage,” Frontpoint Health CEO Brent Korte told HHCN. “The home health industry is going to see disruption in 2024 and subsequent years. It’s an exciting time to be part of this industry.”

Labor difficulties

Accurate Home Care CEO Bill English quipped at Aging Media Network’s Continuum conference that, if 200 nurses showed up in his parking lot tomorrow, he’d hire them on the spot without conducting interviews.

Though there’s been some investment in home health nursing platforms by companies like LHC Group and BrightStar Care, there’s still a severe nursing shortage. On top of that, home health care tends to be a more difficult sector to recruit nurses to.

“There are plenty of challenges on the horizon, but America needs more nurses,” English told HCHN. “It will take another 5 to 10 years for supply to meet demand.”

That supply and demand will result in increased costs for home health providers yet again, Intrepid USA CEO John Kunysz added.

“I believe 2024 will include continued scarcity of labor and pressure to increase labor wage rates across the board — particularly for patient-facing team members,” he said.

That’s where the Centers for Medicare & Medicaid Services’ (CMS) rate cuts really hurt.

Providers are having to pay more for nurses than ever. Rate increases from CMS – or MA plans, for that matter – are not keeping pace.

That leaves the industry in a precarious position. Home health leaders are left to scramble for ways to become more efficient with the same amount of nurses and caregivers.

“We can find better use of technology and virtual care models to create at least a 30% increase in labor productivity for our existing labor resources,” Kunysz continued. “The supply isn’t increasing, so you have to drive labor efficiencies and productivity through technology that also reduces the burden on clinicians.”

Integrating AI

Slimmer margins and labor challenges will all but force providers to consider utilizing AI and other technologies in 2024.

They won’t be able to put the cart before the horse, however. AI tools will be rendered useless if there’s not enough quality data to be inputted into those tools.

VNS Health CEO Dan Savitt believes a heavier reliance on those sorts of tools will be table stakes in the future.

“The use of technology — including AI — is evolving quickly in home health care to improve patient outcomes, reduce the administrative burden on clinical delivery and improve administrative efficiencies,” he said.

In looking for that 30% increase in productivity, Kunysz and Intrepid are also looking at AI as a potential solution.

“We’re finding ways to integrate AI into our clinical documentation processes to reduce the variability of the documentation quality and reduce the time burden on clinicians,” Kunysz said.

Home care providers are also looking to integrate AI to solve similar challenges.

The cost of delivering home care has skyrocketed. Agencies either have to raise the billing rates – pricing a group of clients out in the meantime – or find better ways to keep the cost of care down.

Reducing caregiver turnover, for instance, is one way to keep costs down.

“There are a range of ways AI can be applied to caregiver recruitment and retention,” Griswold CEO Michael Slupecki told HHCN. “From writing job postings, to chatting initially with applicants, to scheduling interviews, AI can eliminate several time-consuming steps in the hiring process. Once onboarded, AI can drive ongoing caregiver engagement to measure job satisfaction, provide rewards, give recognition, and even assign training.”

On the client side, providers also see AI as a tool to deliver better care.

“Increased capacity for predictive modeling through AI will empower home care leaders to enhance service offerings to improve the quality of care, patient health, comfort and independence,” Emma Dickison, the CEO and president of Home Helpers, told HHCN.

Slupecki added that predictive analytics driven by data and AI can aid in fall mitigation, UTI detection, medication adherence and other areas.

“AI technologies are changing and improving faster than we can implement and will impact the future of home care indefinitely,” he said.

The post How Medicare Advantage, Labor, AI Will Shape Home-Based Care In 2024 appeared first on Home Health Care News.

In 2023, the decreasing influence of COVID-19 did not mitigate the overall operating pressures home health providers were forced to face. In the new year, there still remains plenty of opportunity, but much to work through to tap into that opportunity.

More proposed rate cuts to home health reimbursement are expected from the Centers for Medicare & Medicaid Services (CMS). All the while, Medicare Advantage (MA) penetration is likely to continue.

By midyear, three – or more – of the largest home health entities in the country could be owned by payers. That could impact the industry at large in a number of ways. Providers not owned by payers will still have to find better ways to work with them, whether that’s through higher-rate contracts or more value- and risk-based ones.

But the home is where care is headed. Longstanding providers stand to benefit from that, so long as they can get their ducks in a row operationally.

Below are all of the home health trends HHCN believes should be on providers’ radar in 2024, based on research, reporting and extensive industry knowledge.

Curious what we forecasted for last year? Revisit our 2023 predictions here.

HHCN’s home care trends predictions, published last week, can be revisited here.

The fee-for-service landscape of yesteryear will be no longer

For years, home health providers were able to rely on the sturdy support of traditional fee-for-service Medicare reimbursement. That will no longer be the case in 2024 – and beyond.

CMS, in a vacuum, provides a reasonable rate for home health services. If providers weren’t aware of that, the the Medicare Payment Advisory Commission (MedPAC) is happy to remind them. 

MA beneficiaries have been growing steadily for the past decade, but providers in certain markets were able to stave off poor rates. A healthy mix was achievable, with a heavy reliance on the fee-for-service dollar. 

But, in 2023, over 50% of Medicare beneficiaries were underneath an MA plan, according to the Kaiser Family Foundation. That number is expected to continue ticking up.

On the other end, CMS is seemingly hellbent on denying traditional Medicare rate increases in the future, despite inflationary pressures.

From a reimbursement perspective, the walls are caving in on home health providers from both sides.

“The trend in Medicare Advantage continues to just rapidly outpace preparation by the industry,” New Day Healthcare CEO Scott G. Herman told HHCN in December. “Unless you’re building something specifically for MA, the ability to hold the 50-plus percent of traditional Medicare episodic mix in home health – it’s really just gone.”

In 2024, with the fee-for-service model eroding, home health providers will have to invest in operational models that can withstand MA rates and stagnant traditional Medicare rates.

Risk- and value-based care represent an opportunity for providers to get closer to what they believe they’re owed, so long as they can find partners willing to enter into appropriate agreements with them.

“We’re focused on understanding exactly how those Medicare Advantage players work, building remote models that support them, that are driven with data and analytics,” Herman continued. “We need to sit down and understand how to work with patients longitudinally, how to do cross referrals internally, and then take the business that those players really need us to take in markets where they’re struggling with providers.”

It will become clear whether payers will be allies or foes in home health care 

UnitedHealth Group (NYSE: UNH) and Humana (Nasdaq: HUM) are two of the biggest health care companies in the country. They’re also both now heavily involved in home health care.

On UnitedHealth Group’s end, it owns LHC Group and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED). Humana, of course, owns CenterWell Home Health, formerly Kindred at Home.

Legacy home health providers have mixed feelings about whether these companies being in the home health business will be a good or bad thing.

Some providers feel queasy about it, knowing that they’ve been at odds with these players before in MA negotiations. Others believe more eyes and more investment in home-based health care is always a good thing.

But advocacy efforts will offer a first glimpse at whether these players will be behind home health providers’ universal causes.

“We start processing all of this, thinking, ‘OK. Is this a good thing or a bad thing in the aggregate?’” National Association for Home Care & Hospice President William A. Dombi told HHCN last year. “And I think we start seeing some really positive elements to it. There may be a home care company who would disagree with that, for their own personal circumstances. I can respect that and understand it, but at the same time, how do we take the energy entering into this space and really turn it into something positive for everyone?”

CMS is likely to propose more rate cuts in June. When it does, it will become more clear whether the large payers are willing to fight alongside home health providers. Alternatively, it could show they’re more focused on MA policy, and view home health care as more of a side project.

More payers will lessen, remove prior-authorization requirements for home health services

Medicare Advantage penetration gives MA plans an inherent advantage. But more care shifting to the home, in part because of shifting patient preferences, gives home health providers an advantage in negotiations.

Home health referral rejection rates are at an all-time high, according to companies like WellSky that track such things.

Plans unable to work well with home health providers will lag behind. Their beneficiaries will need home health services as much as ever.

Outside of rates, providers have expressed prior authorization requirements as one of their top gripes with plans.

“The prior authorization process should be based upon the patient’s primary diagnosis and have a standard number of visit authorizations based upon evidence-based medicine,” Intrepid Healthcare CEO John Kunysz told HHCN in October. “Care delayed is care denied.”

In 2023, providers began to gain momentum in terms of lessened or removed prior authorization requirements. HHCN expects that momentum to continue in 2024. It makes sense for the providers and patients.

BCBS of Massachusetts removed prior authorization requirements for home care services last year, recognizing that patient care was being delayed.

“By removing prior authorization requirements for home care services, we’ll help hospitals to expedite discharges at a time when many are struggling with overcrowding,” BCBS of Massachusetts Chief Medical Officer Dr. Sandhya Rao told HHCN in November. “This change will also reduce delays for Blue Cross members ready to transition their care from hospital to home.”

Cigna (NYSE: CI) did, too. The company removed hundreds of prior authorization codes in 2023, and is in the process of doing the same for MA, specifically.

Expect ‘passive acquisitions’ and accelerated consolidation

Home health operators face a mountain of challenges, from the unrelenting labor crisis and skyrocketing demand, to the margin shrink tied to contracting fee-for-service rates. Simply put: The cost of doing business is higher than ever.

And that’s unlikely to change in 2024.

In light of that reality, HHCN anticipates further consolidation for the home health industry over the next 11 months. That consolidation will happen in the form of M&A activity, agency closures and “passive acquisitions,” or one provider agreeing to take on a distressed provider’s patient population.

There are signs that this accelerated consolidation has already started.

In August, St. Joseph’s Health revealed plans to close its home health care agency, citing economic challenges. Around the same time, a home health program in Alaska was forced to shut down “mainly due to federal regulations that make operating it challenging and inefficient.” A few months later, Boone Health announced it was closing its home care and hospice service lines.

On the M&A front, the fourth quarter of 2023 brought at least 13 home health-related transactions, according to data from M&A advisory firm Mertz Taggart. In terms of volume, that tied for the second-most deals since the end of 2021.

It’s important to underscore that consolidation alone isn’t HHCN’s prediction, as consolidation in the home health industry has been happening for years.

In fact, the home health industry has actually seen its number of active agencies decrease since at least 2014. According to data from the most recent Home Health Chartbook released by the Research Institute for Home Care (RIHC), there were 11,353 active home health agencies in 2022, 11,474 in 2021, 11,565 in 2020, and 11,569 in 2019.

HHCN’s forecast, more specifically, is that the pace of consolidation will speed up by a noticeable degree.

The public market will look different

Every new year brings new speculation in the home health space about which companies could go public and which publicly traded companies could change ownership.

In the years following the COVID-19 pandemic, many home-based care companies considered going public, but their tuned change when the economy took a downturn.

There are a few companies HHCN is keeping an eye on, starting with Enhabit Inc. (NYSE: EHAB).

The home health and hospice provider is possibly headed toward a sale. It’s not unrealistic to expect the company to end up in the hands of an already publicly traded company – that would be acquiring the company for strategic purposes – or a private equity firm. 

On the other side of things, BrightSpring Health Services has filed for an IPO and is eyeing a $3.1 billion valuation.

The home- and community-based services provider first planned to go public with a goal of raising $800 million in 2021. The company nixed that plan soon after, but is running it back.

Help at Home, another home- and community-based provider, is also reportedly gauging interest in a sale. The company, backed by The Vistria Group and Centerbridge Partners, has been rumored as a potential candidate for an IPO in the past.

Payer innovation teams will play an even greater role at their organizations

In a move to diversify payer sources and embrace value-based care, some of the largest home health companies in the industry have thrown their weight behind internal payer innovation teams.

In 2024, this will only intensify, as providers look to rely less on fee-for-services Medicare.

In this respect, companies like Enhabit, Bayada Home Health Care and VNS Health are already ahead of the pack.

As a result, Bayada has been able to increase the amount of managed care revenue tied to the company’s value-based contracts. VNS Health set its sights on taking on more risk, and has also achieved 68% managed care penetration in New York. Enhabit has negotiated agreements with 37 — and counting — MA and commercial payers.

Ultimately, providers that have put payer innovation front and center at their organizations believe that it has allowed their companies to operate more autonomously.

“It allows us not to be beholden to one individual payer, if we’re having a difficult negotiation,” Devin Woodley, vice president of managed care contracting and B2B sales at VNS Health, previously told Home Health Care News. “It also helps us on the referral side. One of the reasons why referral sources love us is because we’re contracting with, essentially, every major payer.”

More home health providers will incorporate mental health care

It’s been well established that seniors prefer to age in their home, and receive care there.

Concurrently, the demand for behavioral health services in the U.S. has continued to skyrocket in recent years.

This, naturally, opens the door for home health providers to reach a patient population whose behavioral health needs are often underserved.

Specifically, fewer than 50% of seniors with mental and/or substance use disorders receive treatment, according to the National Academy of Medicine.

Some providers have already stepped into this opportunity to deliver care to this population of older adults. Innovive Health — a Medford, Massachusetts-based home health company — has made offering care to Medicaid-eligible seniors with severe mental illnesses a priority.

“They’re a very challenging population to treat and manage,” CEO Joe McDonough previously told HHCN. “They’re often resistant to care. There’s a lot of social determinants, as far as having adequate housing, adequate food supply, adequate access to medications. This is a population that continually has challenges, as far as access to care.”

Due to Innovive’s care delivery model, the company has seen positive outcomes among its patient population.

“We’ve seen a market decrease in hospitalizations as well as ED utilizations in this population,” McDonough said. “This is because we provide intensive case management. We also ensure medication compliance, and coordinate with all providers to make sure that they have a treatment plan that assures the most optimal outcomes.”

Additional contributions from HHCN reporter Joyce Famakinwa, HHCN reporter Patrick Filbin and HHCN Managing Editor Bob Holly.

The post Top Home Health Trends For 2024 appeared first on Home Health Care News.

Home health leaders are focused on mitigating margin compression, utilizing more technology, leveraging artificial intelligence, working smarter with MA plans and more in the new year.

Home Health Care News heard from six of these home health industry leaders, who shared their views on the biggest trends, challenges and opportunities that will define home health care in 2024 and beyond.

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We will continue to see the importance of traditional Medicare in the home health industry with increasing momentum on Medicare Advantage. Data and analytics to drive the value proposition will be an important focus for 2024. It will be essential that the industry has the data and outcomes to show the broader value impact — in addition to capacity, home health provides a more positive patient experience with lower costs.

We will continue to see labor challenges impacting market capacity. In addition, the impact to margin of the payer mix and specific payer strategies designed to maximize care will be critical in 2024. Exploring innovative ways to use technology and its effect on potential efficiency and care delivery will continue into 2024 as well.

I see home health as a huge driver of cost savings as well as offering better quality of life and outcomes for patients in 2024. The need to convey that to the payer community and the government is important. We should drive for efficiency as a challenge in 2024, but also to unlock opportunity. Care coordination with other important social determinant drivers – like personal care, transportation, meals delivery and physical activity, as well as clinical care coordination with the health system, primary care doctors and emergent referral sources for quality and timeliness of care, will all be important in the upcoming year.

There is great opportunity in market growth, as more and more people are in need of home care services. We will look to grow capacity in the market through workforce solutions, efficiency and unique partnerships of care delivery and coordination, all driving more market growth.

– Richard Ashworth, president and CEO of Amedisys

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Several challenges from 2023 continue to impact home care — most notably, the recently finalized 2024 cuts to Medicare home care reimbursement rates. We will continue to advocate a rollback of these cuts, and with support for our position in Congress, we’re optimistic progress will come.

As the labor shortage continues, home care patient referrals continue to go unfilled. Recruiting and retaining talented clinicians is critical. We can expect more flexible hiring approaches including part-time positions, flex-time scheduling and gig labor across the industry.

2024 will bring growing emphasis on insurer efficiencies in coordinating home care services. For example, several national health plans are already taking steps to reduce authorization requirements and in a push to consolidate the managed long-term care (MLTC) market. In New York, the state is requiring low-performing MLTC plans to be absorbed into higher-performing plans — a process that’s now underway. Look, too, for insurers to accelerate the shift of dual-eligible Medicaid recipients to integrated Medicare-Medicaid plans — a trend we’re seeing in New York State and among national for-profit Medicare Advantage insurers.

Growth opportunities in 2024 include increased linkage of home care patients to community-based mental health providers — a promising option for addressing America’s mental health crisis. The use of technology — including AI — is evolving quickly in home health care to improve patient outcomes, reduce the administrative burden on clinical delivery and improve administrative efficiencies.

– Dan Savitt, president and CEO of VNS Health

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In 2024, I believe small agencies who are barely profitable will continue to hang on, mainly because the owner can’t sell at a price point the owner personally needs. But running the agency will continue to take an emotional toll for those owners, further tiring them and creating a greater clash point down the road.

There are plenty of challenges on the horizon, but America needs more nurses. It will take another five to 10 years for supply to meet demand.

– Bill English, president and CEO of Accurate Home Care

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I believe 2024 will include continued scarcity of labor and pressure to increase labor wage rates across the board — particularly for patient-facing team members. I expect continued expansion of MA plans into rural markets. The biggest health care reform we could pass would be to prohibit the use of the term Medicare in any of these commercial insurance products. It’s completely false advertising.

There will be tight access to capital to support acquisition roll ups due to high interest rates, increased political uncertainty and tension that prevents us from having a cohesive national approach to funding the aging-in-place goals everyone wants.

Other challenges ahead include margin erosion due to increased labor costs, reduced revenue associated with Medicare Advantage plan penetration and a lack of top-tier management talent that is as skilled and adaptable as we have seen historically in the acute care market segments. We simply need more leaders who instinctively innovate and solve problems versus clinicians and managers waiting to be told what to do by their large financial planning and analysis teams.

As far as opportunities go, we’re finding ways to integrate AI into our clinical documentation processes to reduce the variability of the documentation quality and reduce the time burden on clinicians. We can begin to work with payers to shift our care focus from post-acute and measuring hospital readmission rates, to a more pre-acute and aging-in-place model measuring unplanned hospital admissions in the first place.

There’s also room for better integration and utilization of non-skilled home care as the driver for entry into the post-acute care continuum versus acting like it’s 1969 and we’re all looking for our next Medicare patient discharge following a five-day hospital stay. We can find better use of technology and virtual care models to create at least a 30% increase in labor productivity for our existing labor resources. The supply isn’t increasing, so you have to drive labor efficiencies and productivity through technology that also reduces the burden on clinicians.

– John Kunysz, president and CEO of Intrepid USA Healthcare Services

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From where it stands now, 2024 will be the first year that most states will be tipping over 50% of Medicare Advantage penetration. Nationally, we will all have to contend with the reality that MA is here to stay and about to define the way we provide care.

On the latter point, 2024 is the year for tomorrow’s home care provider to build plans on how to thrive — not just survive — with Medicare Advantage. The home health industry is going to see disruption in 2024 and subsequent years. It’s an exciting time to be part of this industry.

– Brent Korte, CEO of Frontpoint Health

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The market has never lost confidence in home health’s ability to grow — nor lost confidence in the importance it has in the post-acute segment. I think confidence will restore as acquisitions occur and more focus comes on it. I think you’ll begin to see the market dynamically shift back toward investor prowess in the M&A piece. Folks are going to want to be invested in the long-term mechanics of home care.

The trend in Medicare Advantage continues to rapidly outpace preparation by the industry — unless you’re building something specifically for MA. The world’s changed. The ability to hold the 50-plus traditional Medicare episodic mix in home health is really just gone. It’s just not something that occurs in the markets we look at. It’s very difficult to hold that type of mix.

Now, the ability to expand the business and expand episodic care, unfortunately, comes with the failure of some smaller companies or the acquisition of those companies so that we can grab that market share and grab episodic business.

What our company is doing is, we’re focused on understanding exactly how those Medicare Advantage payers work, building models that support them that are remote and that are driven with data and analytics through our Carelytics system. Models where we can sit down and understand how to work with patients longitudinally, do cross referrals internally and then take the business that those payers really need to take in markets where they’re struggling with providers.

It comes from creating a very efficient model of care delivery, which is predominantly focused on having the finite nursing resources and managing that to the absolute best of our ability. In our case, anything that does not have to be managed by a nurse, we take it out of their hands and we manage it by others. We don’t want them to work on those tasks. We’re focused on the execution of highly capable nurses and the things that only they can do.

– G. Scott Herman, founder and CEO of New Day Healthcare

The post 2024 Executive Forecast: What 6 Top Home Health Leaders Expect Next Year appeared first on Home Health Care News.

Tracking various data has become a common strategic tool for home health providers. In the process of examining data closely, providers have seen several stories emerge.

Intrepid USA is tracking data in a number of different areas, but namely in labor utilization.

While tracking labor utilization – particularly visits per episode and trend lines relative to labor dollars per patient census – Intrepid was able to see certain pain points come into full view.

What’s more, the company was able to discover the story behind why these challenges were occurring in the first place.

“You sit there and you go, ‘Why does this location have such higher labor dollars than other ones,’” John Kunysz, president and CEO of Intrepid USA, told Home Health Care News. “What you can find out is that you have inefficiencies in the way you’re deploying your labor. Maybe they’re using too many PRNs, or they have too many contract nurses, and clinical resources there that are skewing their labor dollars.”

Intrepid USA is a Dallas-based home health and hospice provider with more than 60 locations across 17 states.

Getting the story behind these findings is especially important because labor represents more than 50% of Intrepid’s costs within the company’s home health and hospice business, according to Kunysz.

“It’s the one where you can get out of control real quickly on your profitability,” he said.

Like Intrepid, VNS Health also tracks a variety of data. One set of data that has been a big area of focus for the company are patient outcomes.

“Based on our assessment at the start of care, we apply different interventions to help patients improve from their baseline,” Catherine Schaefer, associate vice president of quality assurance and performance improvement at VNS Health, told HHCN. “We monitor that at the patient level, and then we’re able to aggregate that data and look at it agency wide. We can align that data with different patient characteristics, like certain types of diagnoses and comorbidities. How many times the patient has been in the hospital, for instance. It gives us a lot of insight into our patient population.”

New York-based VNS Health is a full-service home health care organization. The company has almost 40,000 patients in its care on any given day.

The insights that VNS Health gathers from this data helps its clinicians determine what interventions to apply in order to see patient improvement.

A few years ago, VNS Health discovered some of their clinicians didn’t have a solid understanding of how to answer OASIS questions. The company has an analytics platform that generates alerts for inconsistencies in the assessment data.

This led to VNS Health implementing a targeted performance improvement project, according to Schaefer.

“We extracted that data,” she said. “We analyzed it. We identified this select group of clinicians, and then we conducted targeted re-training. We brought them in and we had classroom training. We had some people go out on co-visits with them, and provide coaching and more education. Because of that intervention, we were able to move our quality of care star ratings from three stars to four and a half stars.”

Data awareness

Frontpoint Health is a self-described “data thirsty company.”

“We want to be the most data-driven home health and hospice organization in the country,” Frontpoint Health CEO Brent Korte told HHCN in an email.

Dallas-based Frontpoint Health is a home health and hospice provider that specifically goes after Medicare Advantage (MA) patients.

The data topics Frontpoint Health looks at include quality of care, clinician production, back office support, patient experience, financial numbers and insurance and billing proficiency.

In general, data has helped Frontpoint Health shine a light on some weaknesses. For instance, when digging into Medicare financial data, PDGM emerged as a weak spot for the company.

“When we looked at our data, comparing it to industry benchmarks, we were somewhat behind in PDGM,” Alex Van Gundy, manager of data and business analytics at Frontpoint Health, told HHCN. “Being mainly a Medicare Advantage provider, we didn’t have as much experience with PDGM. We figured we could probably have the biggest impact in educating our staff on that model.”

Gundy believes that having data allows the company to be proactive, versus reactive, in its decision making.

Similarly, Kunysz pointed out that many view data through a retrospective lens.

“You should be tracking data and metrics that are, what I call, real-time metrics,” he said. “Data that is predictive of future results versus indicative of past performance. At the speed with which we have to adapt and adjust — the different kinds of patient mixes and labor utilization, and just the availability of limited resources and thin margins — you have to be really efficient and proactive.”

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After the U.S. Centers for Medicare & Medicaid Services (CMS) released its CY 2024 final payment rule Wednesday, home health providers found themselves in a position they know all too well.

Is a 0.8% aggregate payment increase better than the 2.2% decrease that was proposed? Of course. Was the rule, in its totality, effective in easing the payment concerns of providers moving forward? Of course not.

The home health industry’s last few years have been filled with long, hard advocacy battles between the proposed rule and final rule. Like the early 90s Buffalo Bills, those advocacy seasons have been successful, but none of them have ended up with the ultimate goal achieved: a Super Bowl win, or a total nixing of present and future home health cuts.

Both last year’s final rule – a 0.7% increase – and this year’s final rule offered providers a breather. It’s a breather that doesn’t last long.

CMS stands by its methodologies for evaluating the budget neutrality of the Patient-Driven Groupings Model (PDGM), and also believes it overpaid providers to the tune of $3.4 billion from 2020-2022. That means providers will likely be back in the same position from June to October 2024 as they were from June to October of this year.

It’s an arduous process for everyone that calls the industry home, and it reminds me of something Amedisys Inc. (Nasdaq: AMED) Chairman Paul Kusserow told me in January.

“My concern is the game that we play with CMS,” Kusserow said. “It’s a long, exhausting game. They come up with a proposed significant cut. The whole industry gets all worked up about it and runs to Washington. I’ve done this, and everybody in our business has. We lobby, lobby lobby, they get a lot of pressure, and then they come back with something that is just mediocre. It’s not enough for us to get Congress all worked up about it to pass legislation. But it’s enough to keep us in purgatory. We have to get through this dribbling sense of inadequate reimbursement.”

In 2024, CMS and the home health industry will continue to play that game. CMS has not to this point gotten what it wants, and nor has the home health industry.

This week’s exclusive, members-only HHCN+ Update addresses Wednesday’s final rule, but also addresses what it could mean for the home health industry moving forward.

Short-term wins

Immediately after the rule dropped, trade associations rushed to make sure those paying attention didn’t miss the forest for the trees.

Some of the trees, for instance: the final rule’s difference from the proposed rule will amount to a revenue boost of $26 million for Amedisys and a $18 million boost for Enhabit Inc. (NYSE: EHAB), according to the Jefferies Group.

Smaller agencies will see similar relief from projections stemming from the 2024 proposed rule, relative to their overall revenue. But that shouldn’t satisfy them, the Partnership for Quality Home Healthcare CEO Joanne Cunningham argued.

“To put these numbers into context, the rule finalizes a base rate year-over-year increase of less than $1 per day to care for Medicare’s sickest patients,” she said in a statement. “And while CMS is slightly delaying implementation of the permanent cut for next year, those dollars will be cut from home health in future years.”

In its statement, the National Association for Home Care & Hospice (NAHC) reiterated that it would need continued support from its lawmaker allies in Congress if there was any hope to put an end to future cuts.

The New York-based home health provider VNS Health called CMS’ current path “not good policy, not a good use of taxpayer dollars and not good for patients.”

Its CEO, Dan Savitt, argued that the continued cuts would further reduce patient access, which, in turn, would end up costing the Medicare program more.

“Faced with longer stays, patients with more complex medical needs, and fewer available beds, hospitals are trying to discharge more and sicker patients to home health care agencies,” he said in a statement shared with Home Health Care News. “But amidst a severe and persistent workforce crisis, VNS Health and home care agencies across the country are not able to keep up with this rising demand. Last year, agencies had to turn away about 75% of hospital referrals to home health care. The situation is worse in ‘home health deserts’ – areas already suffering from disparate levels of care where the workforce crisis is even more challenging.”

That’s nearly the exact same tone that Carrie Edwards – the director of home care services at Mary Lanning Healthcare – struck at an aging-in-place hearing held by the Senate Finance Committee’s Subcommittee on Health Care in September.

Edwards painted a more specific picture. As a result of CMS policy, Mary Lanning’s home health arm had reduced its coverage from a 60-mile radius to a 25-mile radius in just two years, undoubtedly leaving home health-needy patients behind.

But CMS either does not seem to buy these claims. That much was evident in the agency’s 531-page final rule.

“In any event, CMS looked closely at our data to ensure the payment rate adequately covers the costs reported by HHAs, without creating unnecessary hardship to providers and maintaining access to quality services for all beneficiaries,” the agency wrote. “Maintaining access is one of CMS’s priorities when making policy decisions. We do not intend to obstruct the provision of home health services to any beneficiary who qualifies for this benefit.”

What’s more, CMS reminded home health stakeholders that even if it did buy the access argument, its hands are tied by law. Congress mandates that PDGM must be budget neutral, and the agency won’t budge from its stance that the model has not been

CMS rebuttals

While CMS backed off more severe cuts, it did not back off its reasoning for proposing those cuts, nor its reasons for implementing the cuts it did.

It even fought back against analyses and comments submitted by providers during the public comment period in its final rule.

On taking into account Medicare Advantage (MA) home health rates, CMS said – more or less – “not our problem.”

“We have never endorsed the view that Medicare funds should be used to subsidize reimbursement rates from other payers – a policy that would be inconsistent with our obligation to be responsible stewards of the Medicare Trust Funds and would ultimately increase costs to Medicare beneficiaries, taxpayers, or both,” CMS wrote. “As we noted in the CY 2023 HH PPS final rule, we responded to this assertion stating: ‘Medicare has never set payments to [cross-subsidize] other payers.’”

Even if that’s the case, though, CMS should refrain from claiming home health providers have sky-high margins. The agency is at least aware that Medicare fee-for-service payments are not home health providers’ singular revenue stream.

And, if home health providers were to ignore those MA patients to chase after the higher margin, over 50% of the Medicare population would be left without access to home health care.

“We observed many methodological weaknesses in the analyses submitted by commenters,” CMS continued. “It is unclear whether the proprietary data on which commenters base their analyses includes referrals from only Medicare FFS beneficiaries or also includes referrals from patients covered by other payers, which means the entire analysis may be inapt for Medicare FFS policy.”

CMS also took issue with the referral rejection rate numbers, insinuating that more referrals being rejected did not ultimately mean fewer patients were receiving care.

“In addition, the proportion of hospital referrals rejected by HHAs does not equate to the

proportion of qualifying beneficiaries who are denied care,” the agency wrote. “The data fails to capture why the beneficiary was rejected – for example, because the analysis focuses on numbers of referrals denied rather than numbers of beneficiaries denied care, the rejection referral proportion could be inflated by a small number of beneficiaries rejected from multiple HHAs, or by beneficiaries rejected from one HHA but who ultimately received care from another HHA.”

All of this is to say, CMS is unconvinced by messaging from the provider community. What matters now is whether Congress is convinced, and willing and able to act on the issue.

If not, home health providers will remain in payment purgatory.

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