Private Duty Provider Joins Bundled Payment Program

Home health agencies are becoming more involved with bundled payment initiatives by the Centers for Medicare & Medicaid Services (CMS), but the private duty side of home care may have a harder case to make to become a partner in these programs. However, one West Coast non-medical provider has managed to prove the value of its cost-effective services and join a bundled payment program.

Los Angeles-based 24Hr HomeCare has partnered with HealthSouth East Valley Rehabilitation Hospital in Mesa, Arizona, in a new bundled payment program to take care of patients following a discharge at the rehab center. The new partnership could underscore a growing acceptance of private duty providers becoming more involved with coordinated care initiatives.

“Our type of industry is frequently an out-of-pocket expense,” Gavin Ward, regional director or strategy and partnerships with 24Hr HomeCare, told Home Health Care News. “More and more hospitals and health systems, and even some payers, are actually starting to fund our type of care as a low-cost, high-touch program that is a lot less expensive that other types of programs. We’re not here to replace anybody, but maybe even supplement a home health type of visit as well.”

24Hr HomeCare provides many in-home care services including personal care, meal preparation, light housekeeping, medication reminders and transportation services. The company has already expanded its services in an innovative partnership with Uber to provide transportation to patients who are discharged from a hospital. 24Hr hopes to help improve patient outcomes with its services, specifically reducing hospital readmissions among this patient group.

Under the new agreement, the in-home care provider will work with patients from HealthSouth directly, rather than the hospital being a referral source. To keep up with the changing partnership dynamic, 24Hr’s care staff and in-office teams will go through some extra training to understand how the bundled payment system works and finesse the case management load.

“These types of programs make our caregivers more aware and more excited to play a role with the heath care community,” Ward said. “Because part of this care plan is really measuring the results of these patients, there’s a little bit more work in regards to documentation and communication between different health care providers that is required.”

Financing Private Duty Partnerships

The concept of bundled payments is still fairly new and aims to reward the quality of services provided to patients across multiple levels of care instead of the quantity. While the fee-for-service era is on its way out as other value-based payment models are implemented, the bundled payment partnership with HealthSouth still works with a fee-for-service base for 24Hr HomeCare.

“HealthSouth receives a flat fee from CMS,” Ward explained. “That’s for the inpatient stay, 60 days upon the admission date at HealthSouth. HealthSouth is responsible for that patient’s next 60 days, whether they remain at HealthSouth or if they are at home.”

The partnership is a Model 3 of CMS’ bundled payment programs, which still works with fee-for-service providers, where the total expenditures for an episode of care are then reconciled against a bundled payment amount that is determined by CMS.

HealthSouth would be eligible for a payment or recoupment amount from by Medicare once these expenditures are compared to the target price. 24Hr HomeCare does not share in those potential savings advantages under the current partnership.

“For us, we are still at a flat fee,” Ward said. “We don’t have risk yet in this. We are paid for the service. It’s fee-for-service for us [paid by HealthSouth].”

Despite not being a risk-bearing entity—and therefore not eligible for potential cost savings payments—24Hr HomeCare is open to taking on more risk in future partnerships, according to Ward.

“We’re having lots of discussions with different entities, but we don’t have anything signed where we are taking on risk yet,” Ward said.

The partnership with HealthSouth could be a game changer, according to Ward, who says the non-medical home care industry is on the cusp of breaking into the mainstream. For now, Ward is hopeful that the data can show better patient outcomes that will boost interest for additional partnerships with private duty providers.

“It’s really going to bring outcomes that are going to shift the industry and put non-medical home care more on the map,” Ward said.

As a private duty company, Ward says his caregivers are becoming a part of history in the changing payment landscape and is hopeful the program’s potential success will drive home the need for these types of services.

“When we have success with these patients, those caregivers realize by those outcomes that there are going to be more and more of these program across the country,” Ward said. “And non-medical home care is just going to grow and grow. They are going to be a part of history proving that our industry bring good outcomes to our communities.”

Written by Amy Baxter