Since the implementation of the Affordable Care Act in 2010, the home health industry has become more involved in accountable care organizations (ACOs), seeing it as an opportunity to stay relevant as payment shifts to reward value rather than volume. However, there are challenges to being selected to be a part of these provider groups, and agencies must continue to pursue strategies that will make them competitive.
Home health agencies need to know how to sell themselves and make themselves known in the industry as valuable partners within ACOs, Scott Vasey, senior vice president of strategy at the Visiting Nurse Service of New York (VNSNY), explained at the Home-Based Care: Financial Leadership Forum in Chicago this week. The event was put on jointly by the Visiting Nurse Associations of America (VNAA) and the Alliance for Home Health Quality and Innovation (AHHQI).
The basic concept of an ACO is that various types of Medicare providers work together to coordinate care better for their patient population, and then they get to share in savings—or have to pay the Medicare program back, if they exceed cost thresholds.
There are now 477 Medicare ACOs participating in the savings programs, and together, those agencies saved the Medicare program $411 million in 2014, according to the U.S. Department of Health and Human Services. While growth in ACOs has been somewhat touch-and-go, with notable participants dropping out, the Centers for Medicare & Medicaid Services (CMS) has introduced new ACO models in an effort to keep the program growing.
Given that CMS is aggressively pushing to move Medicare over to ACOs and other alternative payment models, home health agencies must continue to adapt and fight for a place at the table.
One strategy to help agencies look more attractive to ACO partners is to re-focus business development plans within the agency, Vasey said.
If agencies can shift their focus to be more community-based by initiating partnerships and getting to know other health care providers in the community, and zero in on physician referrals with potential ACO participants, it could help solidify those relationships down the road.
“This is what we’re focusing on right now,” Vasey said. “We are partnering with hospitals in the community and talking to them so they understand the cost savings that can be made from home care.”
The VNSNY is also focusing on aligning the agency with sub-acute providers, health information technology providers and pharmacy partners to boost their attractiveness.
“We are trying to align ourselves because sub-acutes are looking for strategy and they are looking to see how agencies are going to deal with the transition to value-based [care],” said Vasey.
Leading with data
Even further, agencies should be discussing the costs of an emergency department visit at hospitals and readmission costs versus the costs of a home health admission.
Lower costs coupled with a better patient experience can help push some ACO partnerships to form, but, ultimately, agencies need to be their own advocates to prove this.
“Emphasize a better patient experience to be cared for in the home rather than in a facility,” Vasey said.
Agencies should go out and share their data with potential partners and make relationships. But they also need to react to what their market needs and what opportunities are available.
Exploring those opportunities may not always end in an ACO. There are many other pathways agencies can discover that could work better than only ACOs. It may be best to explore all potential options in the value-based care market than just focus on one option.
In addition to ACOs, VNSNY is participating in the Bundled Payments for Care Improvement (BPCI) initiative for patients who have heart disease and who have had heart attacks, Vasey explained. The agency is currently in year three of the bundle, which is focused exclusively on episodes of post-acute care.
“The approach to value-based care should be strategic and also reactive. Agencies should be experimenting in various arrangements.”
Written by Alana Stramowski