Health Plan Executives Rarely Discuss Home Care Models: Survey

A new survey shows that nearly two-thirds of executives rarely meet to discuss home care and only 38% say their organization is performing “very well” when it comes to supporting members’ use of home care services.

Poor communication and coordination among various stakeholders, delayed services and lower member satisfaction are just a few of the challenges facing home care implementation from health plans.

The survey, published by Integrated Home Care Services (IHCS) and Sage Growth Partners, includes the responses from 47 health plan leaders. Some of the findings left IHCS leaders puzzled.


“About 72% of respondents say that strategic drivers were a main reason why care is starting to move to the home, yet two-thirds say they rarely meet and discuss this care,” Paul Pino, chief development and analytics officer at IHCS, told Home Health Care News. “These two are almost diametrically opposed to one another. There’s a disconnect there that really has made us scratch our heads.”

Source: IHCS

Integrated Home Care Services delivers home-based care to over 2.2 million patients through partnerships with health plans and risk-bearing provider organizations.

The company is an independent home care benefits administrator that offers a value-based home care model for managed care organizations.


While Pino is encouraged that health plan executives recognize the growing demand for home care, there is still a lot to be done when it comes to dedicating time and resources to home care.

Over the past five years, 91% of the health plan executives in the survey said that home care service utilization has increased.

However, a majority (60%) said they support members’ use of home care “moderately well.”

If those executives know demand is there, it would be a more relevant conversation, Pino continued. About the same number of executives, nearly two-thirds, said they rarely talk about home care.

“You would anticipate that if they rarely meet to talk about it, they probably don’t have an opinion as it relates to home care,” Pino said. “But they know that it’s a problem, it just hasn’t been a focus.”

Pino believes that the COVID-19 pandemic has something to do with that. Health plan executives have been so focused and engaged with some of the institutional-based components of care that home-based care has not been top of mind, he said.

Health plan executives also have recognized that costs have gone up for home care: 96% of respondents indicated that home care costs have increased over the past five years. Of those, over 25% said costs have increased more than 10%.

That trend might continue for the next few years.

“There is an understanding right now within health care that there’s only so much you could squeeze,” Pino said. “You’re not going to get a significant amount of profitability from over-squeezing the lowest cost provider. If you look at any sort of utilization-oriented trend, and you start looking at total cost per patient and when you compare home care to SNF, SNF typically has 200% the level of reimbursement, on an average per patient basis, than home care would.”

Home health and home care should see slight upticks in costs, Pino said, especially when it comes to managed care.

Home care strategy and optimization continue to be hurdles for these executives as well. Of the 47 executives surveyed, only 36% said they are “very proficient” at assessing home care’s impact on total costs.

These results, although surprising in some ways, were also validating for companies like IHCS who can help bridge the gap between health plans and home-based care.

“The trends that we’re seeing, not only from a utilization perspective but from a cost perspective, continue to rise,” Josh Holmes, senior vice president of business development at IHCS, told HHCN. “The opportunity for a home care benefit and administrator to collaborate with these populations, on behalf of a health plan, couldn’t be better.”

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