Care transitioning remains one of the rockiest parts of the post-acute health care ecosystem.
Home health providers are in the middle of those transitions, often juggling health system and health plan relationships while trying to care for the patient at the center of it all.
The best case for a patient is an aligned health system, health plan and home health provider. Unfortunately, that best-case scenario is rare.
Medicare Advantage (MA) plans, for instance, often pay much lower rates than traditional Medicare. They also have slower authorization processes and are more difficult to access. Providers are often unable to have meaningful discussions with potential payer partners to understand plan objectives and member needs.
“I’d love to [see] faster authorization, better pay, more referrals, better relationship building and an understanding of mutual benefits,” Reliant at Home COO Jana Lightfoot said this week during a Forcura webinar.
The Plano, Texas-based Reliant at Home provides home health, hospice, home care and rehab services across 12 locations.
For home health providers generally, the care transition process tends to be much more dire, as they deal with multiple payer sources, staffing struggles and poor communication from referral partners.
More than 44% of home health care providers acknowledged that delayed or poorly managed care transitions had made very negative – to extremely negative – impacts on their patients, according to a recent survey conducted by Forcura and Home Health Care News.
Lightfoot noted that working with the health systems and health plans to understand and design a mutually beneficial partnership is ideal, but not always possible.
The California-based Kaiser Permanente – which is part health plan, part health system – is trying to do its part to become one of those partners.
“From our perspective, we want to really focus on expediting our pre-service authorization protocols,” Bill Gammie, the senior director of post-acute utilization at Kaiser Permanente, said on the webinar. “We want to make sure that there’s technology access and information flowing so that member isn’t held up. So that discharge planner isn’t frustrated, and so agencies receiving that member aren’t wondering what’s going on as they’re trying to get out to see that member. That process flow has been critical to us.”
Gammie used to be an executive director at Seasons Hospice & Palliative Care, which is now a part of AccentCare, one of the largest home health providers in the country.
He also acknowledged that Kaiser Permanente has begun to trace its steps backwards in order to make care transitions smoother in the future. In the Patient-Driven Groupings Model (PDGM) specifically, a lot of insights can be gleaned after a care transition.
“We’re able to gain a lot of insights, as far as what types of members our agencies are seeing, and what those agencies are constantly having to provide intervention on,” Gammie said. “We’re really evolving to take a more clinical alignment lens, and really start to help our agencies connect with resources we have within the Kaiser Permanente system to be able to support these types of members.”
Though the relationships between all the parties involved in these care transitions aren’t always smooth, alignment is sensical.
In a more value-based care world, a healthier patient benefits all parties. Further alignment on reimbursement should organically help care transitions.
“If you really think about what we’re doing in the hospital, in … trying to take better care of patients, or avoiding them going back into the hospitals or getting sick,” Sandeep Sankineni, regional medical director of advanced care at home at Permanente Medicine, said on the webinar. “Home health is where it starts, and where it ends. That’s the focus, and there needs to be more focus there.”
Because of that, Sankineni said that home health referral rates have naturally increased over time for his organization.
“It’s a push in that direction, it’s a very conscious effort that we need more patients getting that type of care,” he said. “So, we need to work more closely with those partners.”
Home health providers also need to be a part of bridging the gap in those health system and health plan relationships. But they are burdened by regulatory requirements that can make the flexibility the payers want a challenge, Lightfoot noted.
“No one knows how to deliver care to patients in the home better than home health operators,” she said. “We need to be clear about what we’re bringing to the table, while also making it easy on our partners. And that’s always the goal.”
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