How One Home Health Agency Broke Down ACO Barriers

Home health agencies agree that getting invited into accountable care organizations (ACOs) is a priority, though the barriers of entry are typically high. As the health care system continues to align and reward cost savings, home health will increasingly play a more vital role in ACOs.

One Illinois home health agency, Better Care Home Health, Inc., has made its way into an ACO and found success there by proving its value through data. Better Care works with Axxess for its home health software to track and share key data that is valuable to hospitals and can help improve cost savings measures.

The agency serves several counties in Illinois and has partnered with Chicago hospitals and the University of Illinois Hospital (UIH) in an effort to reduce hospital readmission rates and share in Medicare cost savings. The agency is currently working on joining more ACOs after their initial success.


With a year under his belt as part of an ACO, Better Care’s CEO Marvin Javellana sat down with Home Health Care News to learn how home health agencies can break down ACO barriers and drive down cost savings.

How did you get into an ACO? It seems that many home health agencies are interested in ACOs, but most just want to dip their toes in and not make the dive.

My thought is that if you’re going to wait and see, you will be too late. You just have to dive into it. The key for better care is our clinicians, our clinical management. That’s where the rubber meets the road, and that’s what actually gives you good outcomes. These people are going to talk to you if you’re not up to par.


Through connections that we had, we talked to the right people. Who are the right people? Not the case managers. All those case management directors care about is getting those patients out of the hospital and into the home. They don’t care about revenue. They are oblivious to revenue. So who do you talk to? The utilization people. The CFO, the CIO. We were able to know and find those people.

What I did was write them a quick proposal by using public data on how much our hospitalization rates for that particular area—what their current hospitalization rate is and what mine is. If you put us in numbers, you just need to talk to them in their own language. We talk to them about dollars. Then, you support that with: this is what I could save per year if you work with me, because here is my data. Axxess absolutely helps us provide that data.

Are you going through hospitals for the most part, or are you working with any assisted living or senior living providers?

Our business model is that we work with hospitals and payer sources. That’s because it filters all the way down.The majority of these skilled nursing facilities have their allegiances, they have their own. The majority of the hospitals might have their own. If I could present my data to be much better than their own, then they will use me.

Why are you one of the few doing it?

I think there are challenges when [home health agencies] don’t have the data gathering tools. They don’t trust their clinicians to go out there and say, “hey, let me go out there and get those very hard patients.” Because these patients are hard coming out of the hospital. It’s not your community base calling you and saying my patient needs home health, no.

Another challenge is most home health companies are afraid to go to a hospital, because a hospital has their own home health. Well, if your data suggests that you’re doing a lot better than their home health, they definitely would want to work with you.

What percentage of your business is derived from ACOs?

At least 30%.

What percentage of referrals do you get from hospitals?

I would say 70% are a combination of hospitals and insurances, direct from the insurance company. The insurance would probably be about 20%. So, 50% is hospitals.

Did you have to do additional training when you joined the ACO? Did you anything change?

The hospital actually sends a trainer. For example, we work with Loyola’s transplant team. They send an LVAD—left verticular assisted device—and we are all LVAD-trained. It’s prior to getting a heart transplant, it’s like an artificial heart. So, we are doing that. A lot of home healths are afraid, because they don’t think they are competent enough to do it. So our clinical leadership has the competency to do that. So the hospital team comes in and trains our people.

How many ACOs would you like to be a part of?

As many as possible, because you also do not know the future of that organization. You’re riding on an advantage plan. It took two years to get on board. You have to collate that data and see who you can talk to. It takes a while. The insurance company that I work with, it took me a year also. You build that relationship, and what I did was let that person champion me to the higher-ups.

Written by Amy Baxter

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