Tips for Home Health Success in New Payment Models

There are over 80 different payment models in Medicare and Medicaid, but certain strategies can contribute to success in various new frameworks, helping home health agencies increase referrals and stand out from the competition

Alternative payment models can enable agencies to do more for their patients, provide better skills for workers and lower costs, Najla Wahid, program manager for home care and palliative care services at Bon Scours Health System, said Tuesday during a webinar hosted by the National Association for Home Care & Hospice (NAHC).

Bon Secours is a not-for-profit Catholic health system headquartered in Marriottsville, Maryland. It has locations in New York, Maryland, Virginia, Kentucky, South Carolina and Florida.


A handful of payment models can positively impact home health companies including accountable care organizations (ACOs), bundled payment care initiatives, value-based purchasing and models springing from the Medicare Access and CHIP Reauthorization Act (MACRA). Compared to traditional fee-for-service, these alternative frameworks typically involve tying payments to quality metrics, and sometimes involve providers coordinating with each other and then sharing any savings they achieve for the Medicare program by better managing the health of a patient population.

Attract Partners

But before agencies can dive into any alternative payment models, they need to be sure they are fully equipped to handle a partnership, as most payment models require some sort of partnership with either a hospital system or physician group, Wahid explained.


“You need to make sure your foundational operational processes are pretty tight first, because you don’t want to engage in a partnership if you have basic issues in your agency,” she said.

Four areas to check before engaging with potential partners include:

  • Star ratings: ensure star rating is three stars, or above that threshold
  • Readmission rate: make sure it’s lower than network average
  • Resource utilization: rates should be lower than network average
  • Geographic spread: must have sufficient spread and good response time

Once an agency has gotten its operations in check, it needs to understand that these programs are offering an opportunity to rebrand the agency altogether, said Wahid.

“Sometimes a potential partner you’re working with will have a very different view of how things should go than what you may be used to,” she explained. “But as long as it’s clinically necessary care that is best for the patients and aligned with the goals of the program, you have a good chance at building a successful strategic partnership.”

Stay Vigilant

While discussions are happening, and as partnerships form, agencies should also ensure they run a market analysis, agency analysis and outcome analysis, Wahid added.

The market analysis consists of a review of the Centers for Medicare & Medicaid (CMS) maps to determine what alternative payment models are happening in the market as well as if the agency is already receiving referrals from those participants.

An analysis of the agency as a whole is also necessary, which consists of evaluating staff and leaders, case managers, IT representatives and those in charge of data analytics. And the outcomes analysis should investigate if the outcomes of the alternative payment model show value to the potential partners.

“If you’re able to sell your agency well enough, you have a better chance at a risk-sharing partnership, which could open up opportunities for more collaboration in the future,” Wahid said.

Written by Alana Stramowski

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