Former Medicare Chief Says Nonprofit Home Health Agencies Do it Better

When it comes to being a preferred provider for important patient referral sources, not-for-profit home health agencies may have a leg up on for-profits, according to a former top Medicare official.

Jonathan Blum was second-in-command at the Centers for Medicare & Medicaid Services between 2009 and 2014, when he served as the agency’s principal deputy administrator and director. After leaving CMS, Blum took a position as executive vice president of medical affairs at CareFirst BlueCross BlueShield, an independent licensee of the Blue Cross and Blue Shield Association offering comprehensive health insurance products and services in Maryland, Northern Virginia and the District of Columbia.

CareFirst works with 16 preferred home health provider partners, Blum said during a keynote speech last Wednesday at the Home Care & Hospice LINK Conference in Chicago.

Home health providers’  success may become increasingly dependent on being a preferred partner with organizations like CareFirst, Blum believes. And when asked which of their trusted home health partners do the best job, CareFirst’s nurse case managers tend to say that the nonprofits are most responsive, Blum said.

Emphasizing that he was sharing an anecdote and not data, Blum said that he nonetheless believes that “those in the for-profit world need to understand [the] dynamic.” The dynamic specifically consists of nonprofits’ mix of good compliance records and success on metrics such as readmissions, coupled with a willingness to provide services for patients deemed the most fragile and complicated.

“There does seem to be something to do with mission,” Blum said. “This is not to say for-profits are worse than nonprofits.”

Written by Tim Mullaney