Most home care companies are generally committed to a single payer source more than they are the other ones, whether it’s private pay or Medicaid.
But many companies have begun engaging with Medicare Advantage (MA), too, and most all companies have at least thought about diversifying their revenue, at least by a little. Still, there’s generally a company thesis that starts with one payer source.
For the Marietta, Georgia-based AccordCare, that’s not necessarily the case.
“We’re about 50% Medicaid, and then some private pay and some Medicare. But we are starting to see Medicare Advantage and other plans starting to get more into [that mix] as well.” AccordCare CEO Brandon Ballew said recently at Home Health Care News’ Capital + Strategy conference. “And I definitely see that as the future personal care.”
The Medicare piece is part of the equation because AccordCare provides both home health care and personal care, though mostly the latter. The company serves markets in New York, Connecticut, New Jersey, Georgia, South Carolina, North Carolina, Alabama and Florida.
There have been many examples of home care companies trying to broaden their payer reach over the last few years. Private pay remains a reliable leg to stand on for most agencies, but leaders are concerned about rising billing rates and how those could reduce the amount of people who can afford home care’s out-of-pocket costs.
But that’s not the only reason why AccordCare is payer agnostic, and perhaps not even the primary reason.
“I think it started with our caregiver,” Ballew said. “The hardest issue in all of our worlds is basically: Will we have enough staff to provide care? And the answer is no, you will not. So, I need to be able to get folks to meet our patients’ needs.”
On the personal care side especially, travel is an inconvenience for caregivers. It’s difficult to have them moving around a lot, and if AccordCare only works with one type of payer, there will be a smaller amount of patients one caregiver can provide care to, Ballew said.
“If I can now have a Medicaid [client], a worker’s comp client and a VA client all right next to each other, I’m going to have a better chance of building a care team in that geography that will cover that particular group,” he said. “I’ve just got to get smart enough internally to bill them, because they all have different rules and they all make you jump through different hoops.”
That’s why AccordCare trains its caregivers all the same, but with an emphasis on all types of patients.
“[It’s about] figuring out that back office,” Ballew continued. “Clients are a little different, but if I can train caregivers and educate them [the correct way], that’s why we take on all of those payers, so we can build the care team the right way.”
For AccordCare, it’s not a payer source, but instead density, that is king.
Successful payer-home care provider partnerships
As a diversified home care provider, payer relationships are important.
AccordCare has the advantage of being a bit more at scale, which is also a part of its strategy. It wants to have significant density in the markets it serves. And that’s so – maybe unlike smaller home care providers – it can tell payers, “We can take on a decent amount of your beneficiaries.”
That way, a relationship can actually make a dent in payers’ overall spend, which is one of the biggest goals in these partnerships.
Often, payers – of all sorts – like the idea of home care and believe it could help their beneficiaries. But adding that spend needs to be justified. And that’s where the home care provider needs to step in.
“They’ll want to know what’s going to go down and what spend is going to be less than it was before,” Ballew said. “And that’s where we have to come with: ‘Here’s why if you allow me to do this, at this interval, at this frequency for this disease state, you will see lower MLR than you’re used to seeing.”
As a director of GBD Special Programs at Anthem, Jamie Swann is in the thick of these talks between home care providers and payers.
To better support Anthem’s Medicaid long-term support services members in Virginia, Swann helped strike a risk-based deal with the in-home care provider Care Advantage in 2021. She’s looking for more providers to work with in the future as well.
“When I am approaching a provider, I really do want, not just the collaboration on rates or incentive plans – I also want the clinical collaboration. Because at the end of the day, what we’re looking to do is keep these members in their home,” Swann also said at the event. “I need the providers to be telling me, for instance, that we have a roach infestation. … That’s what I need. I need that communication and collaboration so we can meet all needs. And that’s what it starts with – that communication and trust.”
Rates remain one of the largest parts of the equation for providers, though.
That’s a fine topic of conversation, Swann said, so long as it’s in tandem with discussions about what the provider can do and how both parties can come together to make things better for beneficiaries.
“Come to the table holistically,” she said. “Let’s talk about rates, outcomes and collaboration from a clinical standpoint. And that has to be proven out. It takes time. … It does take that commitment to keep coming back to the table to talk about the great things, the good things and the ugly things as well – the things that are difficult to talk about. But if you’re both coming to the table trying to solve [certain issues], then that’s a relationship that you can continue to grow and build.”
To be more equipped for those conversations at the outset, AccordCare is looking to invest in the right analytics and technology that prove its worth.
It’s also waiting for the technology vendors in the space to catch up, to start tracking all the data that matters for home care providers and payers in the space.
“It’s not perfect today, so a lot of it we collect outside of their systems, and kind of do manual reporting and manual tracking on it,” Ballew said. “But I can at least show you how many people went to the hospital. Here’s how many people had a fall. Here’s what we did about it when it happened.”
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