Home Health-Aligned Medicare Advantage Plans Can Separate Themselves From Competitors

This article is a part of your HHCN+ Membership

Medicare Advantage (MA) plans, collectively, were one of the home health industry’s clearest opponents over the last couple of years.

Now, providers are making a distinction in their criticism of MA plans. They’re not all bad. Some are even good.

“I think there’s going to be a real separation between the Medicare Advantage plans,” Well Care Health CEO Zac Long told me. “The ones that view home health providers as partners, versus the ones that view us as commodities.”


That’s a massive win for providers, that even some MA plans – whether regionally or nationally – are becoming easier to work with. In certain instances, forming harmonious partnerships may take years.

Home health providers have been backed into a corner by Medicare fee-for-service rate cuts and further MA penetration. In a backwards way, that’s given them more leverage against MA plans. They’ve put their foot down, which has forced plans to reconsider their relationships with providers, with a recognition that patient access is crucial.

“Do I do what I need to do now to survive?” Healing Hands Healthcare CEO Summer Napier told me, referring to her agency’s thought process in MA. “Or do I make a strategic decision for the future?”


Meanwhile, the MA market is becoming more crowded. There are 3,998 plans available nationwide for individual enrollment in 2023, which is a 6% year-over-year increase. On average, an individual has 43 plans to choose from, more than double the options they had in 2018, according to a Kaiser Family Foundation analysis.

Access to home-based care is paramount for plans from a member recruitment and retention standpoint. It’s also crucial for their bottom line. If members cannot access home health care, they’re more likely to end up in a costlier care setting like a skilled nursing facility, or, worse yet, the hospital.

In this week’s exclusive, members-only HHCN+ Update, I break down why it’s good business for plans to become more home health friendly.

Win-win relationships

Long is one of those leaders who believes that things can, will and are getting better when it comes to MA plan-home health provider relationships.

His organization – Well Care Health – is a Wilmington, North Carolina-based home health, hospice and personal care provider that is family-owned and operated. The company serves 45 counties in North Carolina and South Carolina.

“I do think the next couple of years will be a bit of an acclimation period, as providers across our space reforge and reestablish win-win relationships with payers,” Long said.

Well Care Health has recognized the payers in its area that treat home health care as a commodity, and the ones that don’t.

Like many other home health organizations, it has begun to differentiate the two by allocation of its clinical capacity, which is any home health provider’s most critical resource.

“It really is about the allocation of our clinical capacity,” Long said. “I think we view the management of the clinical capacity – which we work so hard to build – as one of our most precious resources as an organization. We allocate our clinical capacity, in a larger sense, to the payers that view us as a partner.”

In order to become a better partner itself, Well Care Health is enhancing its reporting for payer partners.

Napier and Healing Hands are doing the same. She’s laid out the value of her organization in creative ways over the last couple of years.

“For instance, we’ll say, ‘We’ve had this many audits, and we’ve had 100% success in them,’” she said. “‘We’re 100% RCD, our quality scores are this high, our VBP scores are this above average, our hospitalizations are lower than the state and national average.’”

Based in Wichita Falls, Texas, Healing Hands provides home health, hospice and private-duty home care services in 22 counties.

Healing Hands has held up its end of the value-based bargain. It has laid out the relevant numbers and methodologies to MA plans.

The problem is that many of those plans don’t know how – or don’t want – to use those numbers as a jumping off point to a value-based arrangement.

“We took a fee-for-service rate with an MA payer, and had discussions that we would have a value overlay added,” Napier said. “Well, we believe that they will keep their word eventually. But they don’t know how to do that right now. So, for right now … that’s not as lucrative as it [could be]. And when you have control over a value-based payment, your decisions are not the same as when you have a fee-for-service rate.”

That’s where Long sees opportunity for a more “robust” partnership model with MA plans, one where there’s deeper communication and more aligned payment mechanisms.

And, while he’s optimistic, one of the hurdles that remains is primary contacts or point people specifically overlooking home health care from the plan side.

That’s a thorn in home health providers’ side that I wrote about in an article earlier this month.

For relationship purposes, that primary contact can make all the difference in the world, and put a plan in the “partner” bucket for providers.

“Oftentimes, there’s not a primary contact or an overarching relationship manager from the payer perspective,” Long said. “I think that’s a tremendous opportunity for payers, to invest in those contacts, and to really think about the value in forging and managing those value-based relationships with care providers. That’d do a great deal of good, I believe.”

From the plan perspective, the risk of investing in these partnerships is almost nothing, particularly if the partnerships are under a value-based structure.

The reward, on the other hand, could be huge: easy and timely referral acceptance; patient satisfaction, and thus, increased star ratings; a much greater percentage of post-acute patients in the least costly setting, the home; and a network of trusted providers that can reinvest in their businesses because they’re not being commoditized.

“You have to really make hard decisions,” Napier said. “Do I take what I have to take now to survive, or do I take a little bit of risk for the future in hopes that this partner becomes a true partner? We ultimately have to [dig into] the payment methodologies and see if we can survive if we take this or that rate. And then, sometimes, that means just having to walk away.”

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