Payers See Home Health Providers as ‘Commodities,’ Industry Leaders Say

Home health care is still not being recognized for its inherent value in reducing hospitalizations and curbing health care costs by payers, which often view providers more as commodities than trusted partners. 

“Where are we in home health?” Bruce Greenstein, chief strategy and innovation officer at LHC Group Inc. (Nasdaq: LHCG) said Monday during a panel discussion at the National Association for Home Care & Hospice (NAHC) Financial Management Conference in Chicago. “This is a turning point. Are we just a walker or a wheelchair that’s a commodity product? We’ve been treated like that in the context of Medicare Advantage (MA).”

Lafayette, Louisiana-based LHC Group and its 32,000 employees deliver home health, hospice, personal care and facility-based services to patients throughout 36 states.

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All too often, payers compensate home health companies with the lowest possible rates for their services, leaving providers stuck in a price arbitrage and utilization management cycle that prevents them from ever fully embracing MA, according to Greenstein.

In 2018, Greenstein became LHC Group’s first chief innovation and technology officer. He previously served as chief technology officer for the U.S. Department of Health and Human Services (HHS).

Greenstein was joined on the conference panel by Mary Gibbons Myers, president and CEO of Johns Hopkins Home Care Group; Donna DeBlois, president and CEO of MaineHealth Care at Home; and James Summerfelt, president-elect at the Nebraska Home Care Association. In addition to discussing the relationship between home health providers and payers, panelists also offered insights on partnerships, technological innovations, financial strategies and workforce challenges. 

Along workforce lines, one of the biggest hurdles home health providers need to clear is their own image, as many view the home as the place where nurses and other health care professionals “go out to pasture,” according to Myers, who spent the early part of her career focused on acute care.

Professionalizing home-based care needs be a priority throughout the industry, she said,

“I had such a totally different perception until I got to home care and went, ‘Oh my goodness. These [caregivers] have to be the cream of the crop and the best of the best,’” Myers said. “I don’t believe that is the image we have.”

Moving up the food chain

Being viewed as a commodity by payers is an opportunity for home health to “move higher up the food chain” and prove value in other ways, according to Greenstein.

Data and proven outcomes will be keys to driving that move.

“We have to use our own data to prove that we can make a difference in the critical outcomes of the patient and the total cost care,” he said.

When it comes down to it, MA plans have a hard time with long lengths of stay at skilled nursing facilities (SNFs), excessive and unnecessary use of emergency rooms and preventable rehospitalization. That all includes spending that home health care actively works to reduce.

And home health providers need to regularly remind payers of that value.

“Unless you are in constant contact and direct negotiation with the Medicare Advantage plans, then you are not winning in that relationship,” Greenstein said. “It’s not easy or a short fix, but its something that you have to work on over months and years to get to where you want to be.”

Johns Hopkins Home Care Group has its own in-house payer source, but even that doesn’t erase the challenges that providers generally face.

Baltimore-based Johns Hopkins Home Care Group is a full-service home care provider that offers specialty infusion, pediatric care, home health and private duty services.

“It’s not utopia,” Myers said during the panel discussion. “When you are a part of a system like this, they always expect you to do everything and not get paid for it. We took a different approach to our Medicare Advantage plan.”

To strengthen its position, Johns Hopkins Home Care Group touts itself as an expert in transitional care and care management, while also leveraging its knowledge of overall care in the home.

This approach has allowed Johns Hopkins Home Care Group to negotiate a bundle of visits upfront using its data to show that the home health side of the business has been sound, according to Myers.

“Instead of just sitting back and letting them treat us like a vendor, we’ve forced ourselves to the table and said, “Let’s be partners,’” she said. “We all want the same outcomes, the best care — and low costs.”

Providers should lead with data, identifying the pain points of MA payers. Then, they should help them understand how their organization can solve for those pain points, Myers added.

One factor that’s helping payers get up to speed on the value of home-based care: the moves the Centers for Medicare & Medicaid Services (CMS) has taken over the past two years to allow certain non-medical in-home services and supports as supplemental benefits under MA.

“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,” Christy Vitulli — senior vice president of payer relations and network innovation at Baton Rouge, Louisiana-based Amedisys Inc. (Nasdaq: AMED) — recently told Home Health Care News. “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.”

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