For years, many in the health care industry considered non-medical home care the black sheep of the family, if part of the bloodline at all.
The important intervention proven to help keep seniors out of the hospital and cut health care costs was often written off as a luxury service — and even labeled “non-skilled,” a designation industry leaders have taken issue with.
But all that’s changing: CMS first announced it would allow Medicare Advantage (MA) plans to cover supplemental benefits in 2019, then expanded those allowances even further for 2020.
Now that home care has a seat at the table, payers are taking more interest in home-based services than ever, according to Christy Vitulli, senior vice president of payer relations and network innovation at Baton Rouge, Louisiana-based Amedisys Inc. (Nasdaq: AMED).
HHCN recently connected with Vitulli to discuss the evolving payer landscape, as well as where a home-based care powerhouse like Amedisys fits in.
Below are highlights from HHCN’s conversation with Vitulli, edited for length and clarity.
HHCN: First of all, what are you seeing and hearing from payers right now as it relates to home-based care?
Vitulli: I’m seeing a lot of interest from payers right now in trying to understand the post-acute care solution and the continuum of care that’s available in the home.
I’m also seeing a lot of interest in how that transfers over to value for payers, and it’s creating a lot of good dialogue with our managed care partners.
Interest is higher than ever.
I think payers are recognizing that the cost of health care is not going down fast enough for them. They’re recognizing that populations of their patients and their members are aging, and facility costs are continuing to rise.
As they look for solutions, they’re recognizing that home care is offering high quality [outcomes]. We’re bringing lower-cost solutions to health plans and their members, and they appreciate it.
At the end of the day, I think payers are also recognizing that members want to heal and be taken care of in their homes.
Where does MA fit into this? Is it helping to spark this interest?
Absolutely.
If you look back in time, payers have historically focused on unit-cost initiatives, and unit-cost initiatives have typically drawn their engagement in developing, building, maturing or changing their networks.
If you look out in the marketplace, they’ve got hundreds of network options in any given state. And they didn’t need to get creative about contracting differently with home care providers because it’s all historically been about costs.
As we step back and look at how health care and the marketplace is evolving, institutional costs are getting higher. We’re seeing lengths of stay in the hospital not taper down. We’re seeing premiums still continue to rise at a level that’s equal to or higher than some of the cost performance index metrics that we follow out in the marketplace.
So we’re seeing payers take more interest in not only post-acute care solutions, but pre- and post-acute care solutions. They’re talking to us about how they can keep their acute patients and their chronically ill patients and members out of facilities.
Part of what we’re seeing is because of the emerging benefits in MA plans around home care and the proposed rule for hospice care. We’re seeing a lot of payers explore with us how they can expand the continuum of care they provide in the home, provide solutions to their members that can provide better outcomes and provide a more comfortable and safer place for them to heal at a lower cost of care.
Despite this increase in interest, most plans are still slow to add these benefits. For example, only 3% of MA plans chose to offer in-home support services such as personal care and housekeeping this year, according to AARP. What do you think needs to happen for these expanded benefits to be adopted on a wider scale?
I think this is the calm before the storm. I think it’s happening now.
The conversations in the marketplace are happening as these payers are looking at the benefits and the designs they’re going to roll out with these new offerings.
They’re trying to assess how to integrate them into their care management programs and care coordination programs. They’re working on finding the provider partners in the marketplace that are going to provide them great access to care and outcomes.
We’re in the really early but detailed conversation [phase] of how they’re going to make these benefits work in their new offerings.
I can only assume Amedisys is having a lot of those conversations right now.
We are, and it’s a lot about education. Right now, these conversations are taking place quite frequently.
A lot of these today are around creating a shared understanding about what payer and member needs are, and there’s a lot of education around understanding what companies like Amedisys, which offers home care and home services, can offer to help the plan meet members’ needs.
We’re spending a lot of time talking about how home care is truly not a commodity-based service. We have nurses that are trained, we have therapists that are trained and we have aides that go out into the home — and they’re all focused on keeping these patients out of the hospital.
We’re taking a lot of time to talk about the need for the access points and truly what types of services we can offer in the home today and what type of service might emerge.
We also talk about cost. There’s maybe a misunderstanding in the marketplace about what it really costs to provide access to these types of services in the home.
We’re spending a lot of time talking about value. So when we do spend more time in the home with these patients: What can they expect to see in quality, patient satisfaction, outcomes and total cost of care?
It’s a lot of time defining the value proposition and exchanging information about what that patient care would look like.
Quite frankly, there’s also a little healthy conflict we work through in these conversations, talking about rates, results and how home care in the marketplace has been undervalued.
We are a low-cost solution that drives really good outcomes, and that’s leading to conversations around tests and pilots and new types of initiatives that are emerging in the marketplace.
Are there any tests and pilots you’re working on at Amedisys that you can share?
We’re really focused on value-based contract initiatives.
There are two or three different programs we have emerging in a little over 15 states across the country that range from a basic pay-for-performance opportunity to a limited risk-and-gain share model to even some conversations into the explorations of sharing true risk.
I like to think of it as a ramp to risk.
Five years from now, what do you think the relationships between home-based care and payers will look like?
We’re going to be talking about outcomes, results and how we expand access to care in the home through different services and different solutions that we’re not even thinking about today.
We’re going to be talking about taking care of our members in a lower cost and great setting for patients to heal and age in place.
Is there anything else you’d like to add?
Payment innovation, value-based contracting and expansion of access to care in the home is happening now.
Payers are actively looking for solutions that drive great quality and great outcomes in a lower-cost setting. They’re asking us for increased access to services, and we’re still talking to them about fair payment models, so I think it’s important to recognize there’s a lot of conversation that’s still taking place in that space.
But at the end of the day, these are very exciting opportunities. We are highly engaged, and we — and many of our colleagues — are more than willing and wanting to share risk and participate in these programs.
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