About a dozen years ago when Will Putman took over the business development side of Continuous Home Care, his dad — the co-founder of the company — had an unofficial benchmark nicknamed “blackjack.”
That term, according to Putman, pertained to new admissions.
“We had a small pocket of referral sources back then and understood, to an extent, what home health was,” Putman told Home Health Care News. “When I took over the business development stuff, my dad would be on the road with me and he’d always say, ‘If we get 21 admissions a week, we’re doing great.’ That was where we were at.”
Continuous Home Care is a Pennsylvania-based home health provider with about 350 employees. The relatively small but rapidly growing business has a current active average census of 750 patients.
Over the last decade, Putman — now CEO of Continuous — has relied heavily on building strong relationships with payers, accountable care organizations (ACOs) and care management companies. In turn, he has grown the business significantly as the demand for home health has climbed.
“Back in 2018, we had about 1,600 admissions to home health under Continuous,” Putman said. “Last year, we had about 6,500 admissions to home health. That growth and the scalability of what I feel like my dad and his partner had built is all based on relationships, customer service and figuring out, ‘How do we fit in as a support system to our referral sources to help them succeed?’”
Continuous provides a long list of home health services including skilled nursing, physical therapy, occupational therapy and other assistance supporting activities of daily living. When Putman started, the revenue breakdown was about 60% Medicare and 40% managed care.
The growth of managed care plans in home health has flipped that breakdown over the last four years, Putman said.
“Not only are our members getting the same quality of care, but it’s a cheaper value for these managed care insurances because they’re not paying 12 visits – they’re paying for six,” Putman said. “For us, it’s been important to develop and build really good relationships with Tandigm Health, which is part of IBC’s (Independence Blue Cross) care management arm, with Humana (NYSE: HUM), with Aetna, Optum and UnitedHealthcare.”
Home health providers like Continuous have had to grow their managed care business as Medicare Advantage (MA) penetration increases.
In 2022, more than 28 million Medicare beneficiaries were enrolled in a Medicare Advantage plan, nearly half of the total Medicare population, according to the Kaiser Family Foundation.
The investment into managed care contracts has also given way to value-based care for Continuous. Although the company is in the early stages of its first value-based contract, Putnam sees room to grow and is excited about the prospect.
Needless to say, navigating value-based contracts is different at the small and medium-sized level compared to the bigger players in the space, he explained.
“We had to make sure we can meet certain metrics, and it’s all very exciting,” Putman said. “It’s still new to us. As a smaller company, we have one or two people on the side who work on contracting. We don’t have these big corporate umbrellas that have those real connections, but we also see we’re the ones who are getting out within 24 and 48 hours for referrals because the big players and the hospital systems are inundated with staffing issues or just an influx of Medicare population.”
The uptick in managed care over the past four years, Putman hypothesized, can be traced back to the trickle-down effect of the big players gearing more toward traditional Medicare, or not being able to keep up with the volume of referrals.
Prior to the pandemic, home health providers were only turning down 42% of patients referred to them, according to WellSky.
That number has increased by over 30% since.
Despite the encouraging growth and positive trends in retaining staff, Continuous is having trouble focusing on what priorities the Centers for Medicare & Medicaid Services (CMS) has in a given year.
“The target seems to always move,” Putman said. “I think a lot of people forget what kind of stress we were all under during the pandemic, whether that’s Medicare or the insurers. We just tried to keep doors open. We tried to take care of patients and take care of employees for two and a half, three years. We’re still doing that, and we’re still dealing with that. It’s not like it went away.”
Being flexible and adaptable has become a necessity for providers. When one issue — whether it’s reimbursement, the change to the Patient-Driven Groupings Model (PDGM) or others — seems to subside, another one crops up.
“Right around 2022 or at the start of 2023, the focus became compliance,” Putman said. “We’re heavily invested in that. Now that the pandemic is over, at least in the eyes of Medicare and the insurers, everything goes back to utilization, cost containment and quality. We’re seeing the biggest push now in compliance, and we’re investing heavily into that.”