This article is sponsored by Integrated Home Care Services. In this Voices interview, Home Health Care News sits down with Integrated Home Care Services (IHCS) co-founder Paul Pino to learn the top challenges in the home-based care space, and how the IHCS model addresses those challenges. Pino also shares why he views the IHCS model as “the future of health care.”
Home Health Care News: Paul, what career experiences led you to co-found Integrated Home Care Services?
Paul Pino: In 2007, I joined and invested in the predecessor to IHCS, a company created by our CEO in 1993 whose model coordinated durable medical equipment (DME), home health and home infusion under a capitated payment methodology. We sold that company in 2012, and in 2015 we re-entered the market as IHCS after we received an outpouring of requests from prior payer partners who needed a home care partner that was willing to manage utilization, create and manage networks and adjudicate claims under a risk-based methodology.
Based upon this request, we created a technology-enabled and fully transparent model that is accountable for coordinating all facets of home care services through a delegated, high quality, patient-focused approach.
What are the top challenges in the home-based care space that the IHCS model seeks to address?
Pino: When it comes to the IHCS model, our contracting approach and service standards start with a patient-centered focus and work backwards from there. As I speak, we’re seeing the largest ever increase in homebound seniors. Over the course of the pandemic, we’ve seen a two-and-a-half times increase in the number of homebound seniors over the age of 70, from just below two million seniors to over 4.4 million.
This vulnerable population needs a range of care options, from the very basic services, such as bathing and washing, to high-acuity level services. An example of this would be someone who’s been discharged from a hospital with a wound. We would not only have to coordinate the home infusion medication, the nurse who administers the infusion, and the hospital bed with an air-fluidized mattress, but also provide support if the patient needs help getting out of the bed or into the bathtub.
These additional routine yet necessary functions require coordination, and could be the difference between home-based and institutionally-based convalescence and costs.
What are the top key features in the IHCS model that help solve those top challenges that you just laid out?
Pino: We are both service-type and line-of-business agnostic. Ultimately, we were created to meet all the home care needs of our managed care partners. There are other home care administrator models that focus on Medicare Advantage (MA) and potentially commercial books of business. At IHCS, we not only have deep experience in servicing the MA and commercial populations, but we also have extensive resources focused on the managed Medicaid population.
As a result, we provide all managed care payers and patients delegated administrative services — including coordinating unskilled services such as companion care, attendant care, respite and other services — that members require. We don’t limit ourselves to coordinating highly acute, highly specialized needs. We are a single point-of-care coordinator for all home care needs.
Also, because we see a significant correlation of home care service-types — 20% of DME patients may require home health, 50% of home health patients require DME and 80% and 50% of home infusion patients require home health and DME, respectively — our model offers all of the home care verticals needed for all patients at all times.
What are the most exciting outcomes and anecdotes that reveal how the IHCS model has helped patients, payers and providers?
Pino: The most exciting outcomes are always patient-centered. Across the board, our plan partners will tell you that we have increased patient satisfaction and generated significant applause from patients in terms of having a single partner that can coordinate the entire grouping of home care entities that will be visiting their home.
We have also seen improved health outcomes as measured by correlated, institutional-based metrics, such as average lengths of stay, ER visits and readmits per thousand. A key measurement of our success is the significant reductions we’ve delivered in terms of transfers from emergency rooms to the inpatient setting versus the home setting. These patients now have the resources necessary to convalesce in the home setting.
The reason for these institutional reductions is our ability to staff cases and staff them quickly. We coordinate care as a partner with our patients and providers in mind. As a result of this partnership, we’re able to make a significant impact in the areas where both patients and providers feel the greatest pain point: scheduling and coordinating. There are a significant number of providers and patients that would rather work with IHCS than with health plans because we focus specifically on home care.
Historically, home care is a core grouping of services that only make up four to five percent of a health plan’s spend. Large health plans aren’t necessarily built to manage smaller cost relationships and services. For us, our network participants are the engine that drives our operations and help meet our plan commitments. When it comes to the manner in which we treat, pay and communicate with our downstream providers, you’ll find that we consider them and our employees our greatest assets.
You’ve called the IHCS model “the future of health care.” Why do you view it that way, and how can health providers succeed in value-based systems?
Pino: “The future of health care” is always a tricky statement because we know that health care is an ever-evolving organism. We believe the future is one that allows people to convalesce in a manner that makes the most amount of sense, not only for the patient but also for other stakeholders such as plans and risk-groups that are held accountable for patient care and costs.
Ultimately, as you think about the future, you can see health plans reduce resources surrounding areas that will not create a large enough cost delta from where current practices are to where future practices could be. If you seek to focus a plan’s utilization management on saving significant dollars by maximizing patient outcomes, you’re not necessarily going to focus on home care, but rather on institutional-based spend, pharmacy, specialists and other associated modalities of care that require a heavy focus on fewer, but costlier items.
Our model takes the approach that we professionally handle the tasks that plans don’t have the time or resources to completely manage. We have risk-based, capitated contracts. As a result of this reimbursement, we have extensive performance and service guarantees we provide our plan partners.
Because quality is inherent to every one of our contracts, we’ve been tied to all aspects of health care quality and value-based contracting that have been around for decades. However, these quality metrics are just beginning to be considered by traditional fee-for-service market participants. As a result of our significant quality and audit infrastructure, our plan partners continually monitor our performance and results through our proprietary patient management platform, MedTrac.
Medtrac is an industry-leading and partner-facing system that captures all salient patient, authorization and provider data. This technology is readily and transparently accessed by our plan partners for multiple purposes including monitoring members and contractual guarantees.
Furthermore, our ability to garner, analyze and share sophisticated and massive data sets with our plan partners is key. Rather than dealing with sporadic data streams, we provide a single, consistent and customizable data relay in real time. Plans use this data to make significant decisions and research patient needs. Our ability to trace and track utilization cohorts is significant for health plan finance and case management units.
The future requires sophisticated quality- and data-oriented market participants. More services will go to providers that are fully engaged in whole-person, quality-oriented relationships rather than payment-oriented relationships. Every effort we are leading right now, in essence, will be what all other home care models will follow in the future.
What is upcoming for IHCS over the next year?
Pino: We have a couple of things that are really exciting. One, we’re going to be launching in an additional 12 states on January 1, 2023, with key managed care partners that have seen the impact and value of our model. They are expanding with us into multiple geographies throughout the country.
Currently, we manage about 2.2 million lives. Of those 2.2 million lives, about 60% are managed Medicaid lives, less than 5% are commercial and approximately 35% are Medicare Advantage. We see that membership complexion changing a bit as we expand into additional commercial and MA plans rolling forward towards over three million lives in 2023.
We are also expanding our model to go beyond our core service offerings of home health, home infusion, and medical equipment. We’ve started to consider relationships with companies that are heavily engaged in primary care services rendered within the home. We have also focused on building relationships with home-based providers of companion-oriented services. We are also focused on gathering and democratizing socially-oriented data from the home.
Finish this sentence, the home based care industry in 2022 will be the year of…?
Pino: 2022 will be the year of home-based care transformation. With the recent announcement of potential home health reimbursement rate cuts, many providers are looking at offsetting some of what we’re seeing from a payment standpoint by transforming their models.
I think it’s off-putting that a large component of why we are seeing any sort of rate decrease from CMS right now in Medicare fee-for-service comes from a behavioral assumption element. To combat this reduction and prove out the need for upward adjustments in reimbursement, providers need to move from a P&L-oriented approach in management to a data-driven approach.
Sharing more and cleaner information with regulators and government payers such as Medicare will help demonstrate that the home is indeed the most cost-effective and desirable site of care for patients.
Editor’s note: This interview has been edited for length and clarity.
Integrated Home Care Services (IHCS), the nation’s leading independent home care benefits administrator, offers a value-based, fully integrated home care model for managed care organizations, with a unique model that improves care quality and coordination while reducing administrative costs by managing key functions such as network development, management, credentialing, utilization management and claims. To learn more, visit IHCScorp.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].