How Home-Based Care Providers Can Win Over Policymakers, Payers

Two groups of stakeholders that home-based care providers need to win over in the near-term future are payer leaders and policymakers.

As Medicare Advantage (MA) enrollment grows, providers need to prove their agency’s value in order to maintain a sustainable business. Meanwhile, policymakers need to understand the value of home health and home care for favorable, future-facing regulations to be implemented or withheld.

In order to do that, home-based care providers are emphasizing that education, data and confidence when getting the word out is more important than ever.


“It’s a sad place for home health care in this country that you would have a situation where — because of regulations and sometimes misunderstandings about the work that is done — we’re going to see businesses close and forced to make decisions that would not be in the interest of someone’s best care,” Emma Dickison, CEO of Home Helpers, said recently at Home Health Care News’ FUTURE event. “This is a big problem that we have to solve.”

Proving the value of home-based care

In a world where the value of care is taking precedence over the volume of care, it’s important to show payers that home-based care is cost-effective and improves outcomes.

“In an effective ecosystem of care, this type of care keeps the elderly out of the ER, which avoids unnecessary hospitalizations, which then ultimately diverts nursing home placement,” Tim Hanold, CEO of Care Advantage, told HHCN this week.


The Virginia-based Care Advantage provides a mix of personal care support and skilled services in over 40 locations in the mid-Atlantic. In June, Searchlight Capital Partners acquired a majority stake in Care Advantage, a deal that will likely speed up Care Advantage’s value-based care strategy.

The company has a value-based care partnership with Anthem, which is a unique one for a company like it to have. The two organizations put together a scorecard based on quality results and outcomes, which were determined based on a baseline of Care Advantage and its peers’ performance.

By showing real results to payers and policymakers – like a 57% drop in hospital utilization and 28% drop in ER visits – Care Advantage is able to show the value of home-based care with data.

“It’s lending more credibility for providers and showing [payers and policymakers] that we are really looking to deliver on quality and outcomes first and the rest kind of follows suit,” Hanold said.

Home health misconceptions

Proving home-based care’s worth to payers is one challenge. Proving it to a rotating list of policymakers is another.

When discussing the importance of home-based care to lawmakers in his home state of Washington, or in Washington D.C., Frontpoint Health CEO Brent Korte makes sure to highlight three key points.

“There are three areas where we have excellent tailwinds,” Korte said. “Very simply, home health is cheaper, it’s a safer environment for people and it’s the preferred method of care.”

Frontpoint Health is a new home health provider that is betting big on MA. As the payer environment changes in home health care, Korte said there are still perception hurdles to overcome for his new company and the industry at large.

“A misunderstanding about home health is [people will think] that someone comes in and helps cook meals and does long-hour custodial work,” Korte said. “That’s the biggest myth that we need to overcome. It’s actually this highly, highly professional home health environment.”

Whether it’s at the table with MA plans or discussing the value of home-based care with policymakers, it’s always a good idea to bring up the money, Korte said.

“This example is super regional, but if we’re talking about a hospital stay, one night could cost you $4,000,” he said. “That’s going to likely cover — especially after PDGM — significantly more than 60 days of home health care. Everything is there: the economics, patient safety and people want to stay home. It’s better for them.”

There are also logistical hurdles, like competing with the hospital system lobby on Capitol Hill.

“The hospital lobby and the health system lobby are enormous,” Korte said. “The only way we’re going to enter the hearts and minds of our legislators isn’t going to be an overt financial conversation. We don’t have deeper pockets than the hospital industry. It’s such a relationship game.”

Confidence is key

There also needs to be a sense of confidence from the industry when talking about the value of this kind of care, leaders told HHCN. Home-based care clearly works, and having that in the message is also important.

“It essentially starts creating credibility when we start speaking that way,” he said. “Historically, we’ve asked lawmakers for a reimbursement bump and maybe we haven’t done a great job of underpinning it with the why.”

The message should be clear.

“This is important for your constituency,” he said. “We’re providing this service so that the elderly can live independently and with dignity at home.”

Korte echoed those sentiments.

“I’m not shy to say that I believe home health is behind every great health system’s outcomes. Period” Korte said.

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