Insurer Cuts 8 Home Health Providers

Insurance company Highmark has shed eight Pennsylvania home health agencies from its commercial and Medicare Advantage networks for 2016, a move that reflects insurers’ push to partner with the best performing agencies.

The agencies cut from Highmark’s network include Renaissance Home Care, Inc. in Mt. Lebanon, Pennsylvania; Visiting Nurse Association of Erie County; Titusville Area Hospital Home Health Agency; Abby Health Care, Inc. of Uniontown; Harmarville Home Health Agency; Nightingale Home Healthcare of Western Pennsylvania, Inc. in Monroeville; Superior Home Health and Staffing Inc. in McKeesport; and The Ambassadors Company, LLC in Dormant.

In the past, Highmark has reduced its network by only one or two agencies each year, Highmark’s vice president of market strategy Robert Wanovich told the Pittsburgh Post-Gazette. The insurer also dropped 10 skilled nursing facilities for 2016.

“This is actually an example of Highmark beginning to act differently, as really an integrated health care and financing system,” he said.

This entails identifying facilities that Highmark believes offer access to the best quality service at affordable prices, according to the Post-Gazette.

“We learned that it was very important for hospitals and doctors to have insight into the quality of care and readmission rates that are coming from these types of services,” Wanovich said.

However, the move took some agencies by surprise, particularly those who have been part of Highmark’s network for decades, as there was limited explanation as to why they were being removed. Abby Health Care, for example, had been with Highmark for about 30 years before the insurer submitted notice in October that the agency’s reimbursement payments would be reduced by 21%, followed by contract termination in December.

“That was totally unforeseen,” Connie Slampak, administrator for Abby Home Health Services, told the Post-Gazette. “To have your contract cut for no reason is kind of demeaning.”

Other agencies, like Renaissance Home Care, anticipated the change. As such, Administrator Roselle Tena expanded the business to include services not covered by insurance and established contracts with other insurers. And while losing Highmark “is an extreme impact,” she said her 100-client business likely wasn’t enough volume for Highmark.

“It’s showing the way that home care is moving with this value-based purchasing,” Tena told the Post-Gazette.

A main concern among agencies cut by Highmark has been the effect on the patients and disturbing their care. One woman, 93-year-old Naomi Crapp, told the Post-Gazette that she had been seeing the same care staff through Abby Health Care since she had a stroke over 10 years ago. She has now switched to Aetna in the hopes of seeing the same nurses.

“Disruption is certainly not something we take lightly, but at the same time, our members expect us to provide them with quality, affordable services, so that is the balance we’re always attempting to strike,” Wanovich said. “We believe this is being done in the best interest of our members.”

Written by Kourtney Liepelt