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In July, LHC Group Inc. (Nasdaq: LHCG) Chairman and CEO Keith Myers said he thought conveners were a part of the problem in the rocky relationships between Medicare Advantage (MA) plans and home health agencies.
Since then, both conveners and other home health leaders have had the opportunity to offer their perspective on those sentiments.
At FUTURE, Amedisys Inc. (Nasdaq: AMED) President and CEO Chris Gerard, for instance, stopped short of offering a complete concurrence with Myers. But he did say his company does not think working with conveners is worth its time, given its capabilities.
“We have all of the capabilities conveners have. The one thing they can do for plans that we’re not going to do is manage a network of providers,” Gerard told Home Health Care News. “We can absolutely do what they do when it comes to utilization management. We can get the same outcomes. We can drive savings for the plan. [Given that], it absolutely makes no sense for us to work with [them].”
Specifically, Myers said that cutting out that “middleman” convener would go a long way to mending those MA plan-home health provider relationships.
“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 July. “But I think our biggest problem are the conveners in the middle of all of this.”
Providers were emboldened by that. Many have told HHCN both on the record and off that they felt the same way.
Broadly, they believe conveners “skim off the top of” their bottom lines. MA rates are already lower than fee-for-service Medicare rates for home health services, so that’s doubly frustrating for them.
Providers also believe that conveners can complicate things. Yet conveners believe the opposite – that they make things easier for plans and providers.
Gerard explained the home health perspective with an example.
“Where a convener does not bring value to anybody is when they’re requiring my nurse who will see the patient to call their nurse to basically negotiate visits,” Gerard said. “If we have the capability of getting the right number of visits, we should not be having these skilled people talking to each other and haggling over how many visits someone should get. We can do that all day long without having to have somebody who tells us how to do that.”
The convener perspective
There are home health providers that wish conveners weren’t a part of their industry at all.
But the bottom line is that they are a part of the larger ecosystem. In fact, their place in it is only becoming more cemented as time goes on.
After all, Walgreens Boots Alliance (Nasdaq: WBA) just recently completed its majority acquisition of the home health technology company and convener CareCentrix. CVS announced that it planned to purchase Signify Health – also a home-focused, convener-type company – earlier this month for $8 billion.
Conveners believe they are organizers of the industry and that they lift up all boats.
Providers’ dismay with them could be due to the shifting going on in the home health marketplace, CareCentrix CEO John Driscoll told HHCN.
“If you look at the history, it would be rare to find a situation when new entrants came into a market and the incumbents didn’t complain about something,” Driscoll said. “The challenge that traditional home health providers have with managed care isn’t the conveners. It’s that they have to transition from fee for service to fee for value. And that’s going to be a challenge.”
Driscoll said that CareCentrix is consciously pro-home health provider, and that it will be one of the conveners that’s a friend of the industry. He admitted, though, that that’s not likely the case for every convener.
“Some conveners will be their friends,” he said. “CareCentrix’s strategy is to partner with providers and work with them to improve the reimbursement for everyone. I’m sure that’s not true of all of the conveners. But I think that the industry would gain from starting to make a distinction between complaining about managed care and partnering with managed care where it makes sense.”
The next step in the MA-home health relationship
Gerard’s point is that if Amedisys and other large home health providers can do most of what conveners do, there’s no point in bringing them in to complicate things.
In the past, when a home health provider has come to a plan to say they are not paying them fairly, they generally respond with three points: that the home health provider uses too many visits, that the patients are kept on too long and that the provider does not take enough of their patients.
Amedisys is taking that feedback and using it to their advantage in conversations with those plans.
“That’s when they start to bring in conveners to manage all of those things for them,” Gerard said at FUTURE. “So for us, we’re saying if we could solve all three of those with our own capabilities for you – and guarantee outcomes – let’s have a different payment model. Pay us on a per admission basis. And let us basically guarantee the outcomes around hospitalizations. Let us actually create clinical capacity by optimizing our care for these patients, and use that capacity to take in more members. And that’s when the light kind of went on with many plans we’re talking to.”