Amedisys CEO Paul Kusserow: If Conveners Don’t Change, Their Day Is Coming To An End

Home health providers have been directing ire at Medicare Advantage (MA) plans for some time over what they consider unfair rates for their services. However, especially over the last year, there’s a new target – and that’s conveners.

Broadly, conveners are the middlemen between home-based care providers and MA plans. At their best, they make it easier for providers to conduct business with these plans, and make it easier for plans to work with a wider network of those providers.

At their worst – which is what home health providers’ focus has been of late – is when they’re skimming off the top of already-low MA rates and also acting as a blocker between the decision makers on both ends of the relationship.

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“If they build up the capabilities that we don’t have, God bless them,” Amedisys Inc. (Nasdaq: AMED) CEO Paul Kusserow said Monday night during the J.P. Morgan Healthcare Conference. “Right now, I can take better care of the plan’s patients than a convener can. That’s the conversation we’ve been having. If they don’t change, their day is coming to an end.”

The Baton Rouge, Louisiana-based Amedisys is a provider of home health, hospice, palliative and personal care. It also has home-based, high-acuity care capabilities through Contessa Health, which is a part of its network. That network includes 21,00 employees and 547 care centers throughout 36 states.

Kusserow – who took back his CEO role at Amedisys in November – is a Humana Inc. (NYSE: HUM) veteran, which gives him a unique perspective on what conveners can and cannot do.

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He specifically mentioned three conveners, which he called the major ones: myNEXUS, naviHealth and CareCentrix.

Of course, those three are all owned by some of the largest health care players in the country, all of which have massive MA plans.

Elevance Health Inc. (NYSE: ELV) owns myNEXUS. UnitedHealth Group (NYSE: UNH) owns naviHealth. Walgreens Boots Alliance (Nasdaq: WBA) owns CareCentrix.

“The conveners are, fundamentally, very classic delegated risk,” Kusserow said. “And I come from Humana. So, I’m very used to delegated risk. You give everything over to these people, you give them 85 cents on the dollar. And their job is to go manage that.”

Where conveners started was in skilled nursing facility (SNF) diversion, Kusserow said. That, he explained, they are very good at.

“They’re good at … making sure people who are in SNFs actually go into the home, and they save lots of post-acute costs that way,” Kusserow said.

But for everything else, especially when it comes to contracts with MA plans for home health services, Kusserow believes MA plans need to “change their game,” as do conveners.

In late October, Amedisys announced it had locked in a case-rate contract with CVS Health’s (NYSE: CVS) Aetna. Then-CEO Chris Gerard told other MA plans to “take note” of that deal.

“Let’s talk in case-rate deals like we did with Aetna, let’s go more at risk on things and get them to migrate further,” Kusserow said. “I think if they stay in the delegated game, eventually people are not going to sign up with them. And it’ll really hurt their ability to access home health.”

The market reality will win in the end, he believes. And that market reality is home health providers forcing the issue on getting paid a fair price for their services.

“The conveners continue to push on very difficult pricing and managing visits where they don’t really have the knowledge of producing the best outcomes,” Kusserow said.

Amedisys and Kusserow are not alone when it comes to the topic of conveners. Other providers have voiced similar criticisms in the past.

He’s not the only top home health leader to laser in on conveners, either. 

“I think we’ve done a a lot more with managed care [because of our JVs with hospitals], and I have really good relationships with executives,” LHC Group Inc. (Nasdaq: LHCG) Keith Myers said last year. “But I think our biggest problem are the conveners in the middle of all of this.”

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