Post-acute care has steadily been shifting toward value-based care and away from fee-for-service payment models. But despite the fact this trend is years in the making, many home health providers are still asking themselves, “How do we get started?”
Executives from four different post-acute and value-based care-focused organizations explored that question on Tuesday during a webinar conversation hosted by the health care technology company Netsmart.
“If you’re starting right now, partnering with another organization — especially the payviders — is a great place to start,” Devin Woodley, vice president of managed care contracting at VNS Health, said during the panel. “We’re empathetic towards the provider side. We understand what providers are looking for and where they’re trying to go. Partnering with a payvider or a consultant is the best place to start in order to take those steps in the right direction.”
The New York-based VNS Health is one of the largest and oldest nonprofit home- and community-based health care organizations in the U.S. The company’s service offerings include home health, hospice, personal care, palliative care services, mental health support and more.
In health care, the term “payvider” refers to an organization that operates both as an insurer and a provider of services. Take Humana Inc. (NYSE: HUM), which has CenterWell and then its insurer arms, as an example.
About 25 years ago, VNS Health also built out its own health plan. With over 35,000 members, it’s now where most of the company’s revenue comes from.
By partnering with a payvider like VNS Health, Woodley said providers can avoid a lot of the pitfalls that come in the early days of value-based contracting.
Finding the right value-based partner with similar expectations is another key component in establishing a presence in value-based care, Amy Kaszak, EVP of strategic initiatives at Curana, said during the webinar.
“Finding a partner that will meet you where you are [is also important] so your first step doesn’t have to be into the deep end,” Kaszak said. “There are more ways to do that today like Medicare Advantage plans and smaller organizations focused on the populations that you care for – that’s a great place to start.”
Curana’s multiple business segments include: a provider-led medical group, Curana Health Medical Group; Medicare Advantage health plans from AllyAlign Health; and a Medicare Accountable Care Organization called the Curana Health ACO.
Partnering with ACOs and primary care groups is another strategy that could come with less risk as providers dip their toes into the value-based arena.
“You can take some risk off of somebody else’s risk and that might be a good baby step into this,” Kaszak said. “You can do this and participate in ACOs, often through physician groups that you’re already working with, so you can get the benefit of expanded primary care that will be important for you to take on more risk in the future. Developing those relationships and maybe starting that risk path [there].”
Instead of taking on risks by guaranteeing better clinical outcomes, Kaszak said providers can pivot and instead show health plans they can capture value by having timely initiation of care and other performance-based benchmarks.
“Even when you start to work with a Medicare Advantage plan, joint ventures are great ways to get full buy-in,” she said. “At the same time, not all providers might be ready to jump into that, so starting with a pay-for-performance or other baby steps — maybe working on process measures and not just on outcomes – is a good way to do it.”
Data is also key, both for a provider to prove its own performance and its performance compared to its peers.
“What I would say is love math,” Bruce Greenstein, chief strategy officer at LHC Group, also said during the webinar. “This is really an expression of data. You have to know your own data very, very well. With whom you’ll be contracting with, they’ll have lots of actuaries. They know your data. They know how much you cost and know how much you can save. You have to think about what your value proposition is and how much could be saved just off of your own costs. Then externally, what kind of cost can you save?”
If a provider knows its numbers aren’t up to snuff in the market, it might be better to work on things internally before getting into the value-based world.
“You have to know how you stack up in the rankings,” Greenstein said. “Are you a good provider? Do you finish in the bottom quartile against others in value-based purchasing? If you’re a poor performer, then you might want to just start to work internally to become more disciplined and execute better before you look for a value-based contract. If you’re among the top providers, then you have something really to go and sell.”
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