When home-based care providers think about the “middlemen” they are frustrated with, their minds will likely wander to the conveners in between themselves and Medicare Advantage (MA) plans.
Undoubtedly, some of those conveners play a middleman role, and can strain the relationship between providers, payers and patients.
But they aren’t the only ones. In fact, a middleman is anyone who comes in between a patient and their care provider – whether that be a physician or a home-based care worker – SCAN Group CEO Sachin Jain told Home Health Care News.
“When I think of the middleman, it’s all these kind of middleware companies that are trying to ‘make the system more efficient,’” Jain said. “But in the process, they take a piece of it. And I would say, oftentimes, the piece that they take doesn’t [amount to] the added efficiency that they’re creating.”
The Long Beach, California-based SCAN Group includes SCAN Health Plan – which is an MA plan – as well as multiple service lines, including home- and community-based senior care, home-based palliative care and home-based primary care, among others.
Jain first wrote about the “middleman” problem in an opinion piece in Forbes.
“The main point is that middlemen in any industry should be adding value, and that value should be measured in health care through the lens of whether it actually improves patient care, full stop,” he said.
Home health providers, for instance, are always trying to become more efficient, especially amid the Centers for Medicare & Medicaid Services’ payment rate cuts. In an effort to do so, they form relationships with partners that promise to “fill gaps” or “match supply to demand,” Jain said.
That’s not the case with all vendors or partners, of course. But Jain cautions that partnerships should be absolutely necessary and – again – end up benefiting the patient.
“You may need to narrow the number of parties that you work with,” Jain said. “The truth is that working with vendors, working with external partners, can oftentimes augment your capabilities. But to make those relationships work, in support of patients, there has to be a high degree of coordination, sophistication and relationship management.”
Jain acknowledged that his organization both needs to be aware of this problem and be part of the solution.
“We need to simplify the experience of working in health care, we need to simplify the experience of receiving health care,” he said. “I think a lot of these middleware vendors and middleware companies – my own included – are incredibly well intentioned. This is not a question about intention. This is a question about execution.”
To fix the problem, there’s firstly that idea of a stricter approach to partnerships and being more “conscious” of that increasing middleware. Though a partner may seem like a solution to one problem, they could be just another point that now exists between the provider and the patient.
Another part of what Jain calls a “change in philosophy” is embedding the health plan people in with the medical group people at SCAN.
That could also apply to health plans working with home health providers. When plans and providers have a partnership – and not just a transactional, adverse relationship – the patient stands to benefit.
“They should be members of one team, as opposed to health plan people versus medical group people,” Jain said. “We’ve created these walls and silos that don’t necessarily need to exist. I really like this idea of virtual – horizontal and vertical – integration. … We should be lowering boundaries in health care and making it more seamless, not putting up boundaries.”
This issue exists across the health care system, but is particularly applicable to home-based care providers as new companies come into the space looking to capitalize off of the care-to-home trend.
It’s not to suggest providers shouldn’t have partnerships. Instead, it’s about going deeper with a few partners and considering what an agency can do itself to address an internal problem.
“Years ago, I saw health plan doing vendor partnership, after vendor partnership, after vendor partnership,” Jain said. “And I said, ‘Those are all destined to not produce any real value.’ Because, at the end of the day, it takes so much work to make any one of these things come to life. So, I would go deeper with a smaller number of partnerships.”