Exploring Home Health Care’s ‘Convener Problem’

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When it comes to payment, there are generally two issues that are drawing the ire of home health providers of late: the Centers for Medicare & Medicaid Services’ (CMS) proposed rule for CY 2023 and subpar Medicare Advantage (MA) rates. 

A third one has been added to that list: the role of conveners.

As with most issues in home health care, it bubbled below the surface for a while, then someone finally said it aloud. Now, it’s formed somewhat of a movement.

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It started with LHC Group Inc. (Nasdaq: LHCG) CEO Keith Myers on the first day of National Association for Home Care & Hospice’s (NAHC) Financial Management Conference. He pointed out that he thinks conveners – or “middlemen” – are the real problem in the MA-home health provider relationship.

Two days later, a home health operator posed a question to a panel of experts: “These intermediaries, these companies that tell managed care how to save money by denying care, and then take a layer of the revenue for that service – are they not worse for us than the Medicare Advantage plans themselves?”

There was a pause.

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“Is that a rhetorical question?” one expert responded.

Since then, I’ve spoken with both home health operators and conveners to get a better idea on just how pervasive this convener issue is in home health care. And that’s the topic of today’s members-only, exclusive HHCN+ Update.

The role of a convener

In May 2021, I thoroughly explored the role of the convener. The article was titled “How Home-Focused Conveners Bridge the Gap Between Payers, Providers,” which I’m sure some home health providers took umbrage with.

But there are many different types of conveners. In essence, a convener generally operates between a provider and a payer. It’s the third party arranging or enabling the services – and the eventual payment – taking place.

In personal home care, conveners have allowed more providers to get involved with MA through supplemental benefits. Conveners like healthAlign, for instance, work with payers and thousands of providers to figure out the back-end difficulties between those partnerships. Their services make it much less daunting for home care providers who want to get involved with MA to do so.

“It’s hard to get services fulfilled in the home. There’s a ton of complexity to it,” Andy Friedell, the CEO and founder of healthAlign, told me. “And what payers are saying they must have in order to invest in care in the home is reliable fulfillment, better data visibility and a more simple mechanism for administration. That’s kind of where we’re approaching this from … for providers and payers who want to invest in those services, because there’s those barriers in those three areas.”

Founded in 2018, the Annapolis, Maryland-based healthAlign offers a data-driven platform to its health plans and provider partners. Those providers include national, regional and local home-based care agencies.

Now, the company is also diving into home health care. But hold that thought.

On the payer side, conveners offer the ability to have one go-to source for home-based care, as opposed to hundreds or thousands of different touch points.

But one can see, then, how that leads to burdensome communication on the home health provider side. When the line to “communicate more” with payers is parroted – usually by the payers themselves – it often rings hollow with providers, because they’re working with conveners, and not the plans themselves.

The uprising

The definition of convener can cast a wide net. But some obvious examples are CareCentrix, myNEXUS, naviHealth and even – perhaps to a lesser extent – Signify Health (NYSE: SGFY).

Now, let’s take a look at who owns or backs each of these entities today. Walgreens Boots Alliance (Nasdaq: WBA) invested $330 million in CareCentrix last October. Elevance Health (NYSE: ELV) – formerly Anthem – owns myNEXUS. UnitedHealth Group’s Optum (NYSE: UNH) owns the former startup naviHealth. And Signify Health is potentially on the verge of being acquired, with CVS Health (NYSE: CVS) reportedly in on the bidding.

In short: these conveners aren’t going away. Therefore, if they are as big of a barrier to getting paid as home health providers believe, this problem is a large one, and one that could persist, especially as MA increasingly takes a greater share of Medicare beneficiaries.

What’s most intriguing about the above ties between large health care entities and conveners is that UnitedHealth Group’s Optum is currently undergoing the process of acquiring LHC Group.

Some home health insiders believe that LHC Group’s involvement with a large MA entity could help the MA-provider relationship, and they’re hoping the same goes for conveners – especially after Myers’ above-mentioned criticism.

“I think we’ve done a lot more with managed care [because of our JVs with hospitals], and I have really good relationships with executives,” Myers said in late July. “But I think our biggest problem are the conveners in the middle of all of this.”

Androscoggin Home Healthcare + Hospice President and CEO Ken Albert was more reserved in his analysis, but did tell me, “We do have to explore whether they are superfluous, if nothing else.”

The above-mentioned panelist went on after his “rhetorical question” remark.

“I personally would love there to be a reckoning with these companies,” he said. “They just suck the life out of you.”

What’s next

As healthAlign gets into home health services, I asked Friedell what he thought about this issue.

While he didn’t get into specific details, he offered up that it made no sense to squeeze home health providers, when offering care in the home saves costs all over the place for the payer.

“I think our relationships that we have right now are fairly straightforward, where we are basically allowing our payer partners to transparently adjudicate their own rates on our platform,” Friedell told me. “But we learned early on that while we were often hired to reduce readmissions, the readmission wasn’t the problem. The readmission was a symptom.”

I plan to talk to more conveners more directly involved with home health care in the coming weeks, as providers have urged me to.

The whole issue seems ominous, especially considering the context. Medicare fee for service was the sturdiest leg of the payer stool for home health providers, and now that is being threatened as well.

The first step has been taken, though. Since providers sounded the alarm on the MA issue at large earlier this year, things have already begun to slightly turn.

I talked to Enhabit Home Health & Hospice CEO Barb Jacobmseyer – who has been very vocal about the MA issue – this week.

“They were actually forcing us to deprioritize MA,” she told me. “And we don’t want to be in that situation. But we need them to pay us fairly so that we can proactively take those patients. And I’m encouraged by the initial discussions, but obviously, we can only move as fast as they’re willing to move.”

The initial discussions over conveners should begin to take place now.

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