When the Centers for Medicare & Medicaid Services (CMS) announced it was allowing non-skilled in-home supports to become a supplemental benefit in Medicare Advantage plans next year, it was evident new solutions would be needed to facilitate the addition.
Now, technology providers and in-home care agencies are seeing opportunities to work together to make inroads with MA plans.
One major problem that has stood in the way of home care and home health care working more closely with hospitals, health system and managed care organizations: interoperability of tech platforms.
“In home care, this does not exist and has not existed,” Geoffrey Nudd, CEO of technology company ClearCare, told Home Health Care News. “The home care industry has never had interoperability or [the ability] to connect to payers.”
ClearCare, a home care software company that raised $60 million in funding in 2016, is aiming to facilitate the connection between health systems and payers to home care providers with a new, interoperable platform, Home Connect API. More than 4,000 providers in the in-home care space have already adopted ClearCare’s network of services, and one major franchisor, Comfort Keepers, is working with ClearCare to leverage the technology to forge new pathways in managed care.
Comfort Keepers, which has more than 600 locations and is owned by multinational hospitality services company Sodexo, is currently holding discussions with other health care organizations to forge new relationships and partnerships, according to Saudia Gajadhar, Comfort Keepers’ U.S. director of marketing and communications.
The new ClearCare platform, which connects health systems and payers to home care providers by displaying referrals, patient data and protocols and procedures, is part of the puzzle, as it could have a wide-ranging effect that will make in-home care providers more attractive partners. From reducing hospitalizations and readmissions to simply helping clients live better at home, Comfort Keepers is betting the platform will differentiate its services.
“Aggregating our ClearCare data gives us a better picture of our clients,” Gajadhar told HHCN. “It is innovative work other companies aren’t doing—looking at primary diagnoses overall and making recommendations to care plans and helping optimizing marketing.”
One of the biggest impacts of the tech for home care providers could be an influx of referrals from other health care organizations that discharge patients, fixing the current blind spots in the process.
“More often than not, referrals are thrown over the wall a bit,” Nudd said.
Instead of getting a direct referral to a home care agency, many discharged patients are sent home with instructions and they or their family members end up playing “a game of telephone” to find home care. The platform makes that handoff more precise with an electronic connection between the hospital or payer and home care provider.
Comfort Keepers sees this impact as “huge,” according to Martin Ng, chief information officer at Comfort Keepers Franchising and Sodexo PHS Global Home. Comfort Keepers is planning to roll out the API platform to its company-owned locations and keep the service available for franchisees.
“Marketing to our referral sources right now tends to be something we are doing on the local level,” Gajadhar said. “Being able to provide our company-owned locations with a differentiating level of service helps us look at the big picture from an enterprise level, [helps us] working with larger partners and providing care and services.”
The push toward managed care has also increased pressure on home care providers to provide new data to prove their value.
Under a fee-for-service model, providers need to reveal when caregivers clock in and out and which services are provided to patients. However, under value-based care models, home care providers need to show more data and meet the new needs of payers.
“New needs are emerging from the referring payers,” Nudd said. “First is the ability to follow certain standards of care …. [Second] is the ability to execute the care protocol. … Those are different needs than what has existed for the last 20 years.”
The connections between referring payers will help Comfort Keepers stand out, the company believes.
“To us, overall, this is one of the reasons we are pushing our network—it’s a herculean effort to push it nationwide,” Gajadhar said.
The effort will help the company drive partnerships as it evolves its interests in emerging managed care and MA opportunities, Ng said, in addition to the size of Sodexo as a parent company.
“There’s definitely leverage from a bigger company, at least from an investment standpoint overall,” Ng said. “We have a global strategy and are leveraging that from a technology standpoint. In practice, what it looks like today, we are still working on that part.”
Whether home care agencies adopt technology systems that are interoperable with payers and other health care organizations may be a matter of “when” rather than “if” as a result of the pressure toward value-based care relationships.
“Not all agencies will deploy these capabilities, but those that do will be able to offer better care as an extension of the continuum,” Nudd said. “Ultimately, the standard of the industry is increasing and those that have the capabilities will win. I think these changes are going to be the tide that lifts all boats.”
Written by Amy Baxter