The Centers for Medicare & Medicaid Services (CMS) wants to move health care providers toward value-based care, as do private payers. Home-based care providers have begun to adjust accordingly.
However, participation in value-based arrangements should not be the be-all and end-all.
“I would argue it’s relatively easier to get providers to sign up for value-based care arrangements than it is to ensure they’re successful within those arrangements,” Joel Haugen, senior vice president of product management at Signify Health, said last week during a webinar hosted by Signify and Rise Health.
Dallas-based Signify Health — a part of CVS Health (NYSE: CVS) — is a value-based platform that leverages analytics, technology, health care provider networks and over 10,000 clinicians to power value-based payment programs.
The company’s home and community services division also conducts millions of in-home evaluations per year.
According to Signify, around 35% of all MA members are involved in some kind of alternative payment model. That — coupled with the fact that CMS continues to drive strong incentives to push providers into risk-based arrangements — is an indicator that provider participants in those models “must have skin in the game,” Haugen said.
In order to do that, providers and health plans will need to work more closely together.
One of the ways to do this is to leverage an enabler or a risk-bearing entity that specializes in the success of these partnerships, Haugen suggested.
“Each health plan may have varying levels of quality incentives,” he said. “They may have various levels of PMPM payments, different levels of maturation on analytics and the impact of those care management program collaborations. Is there an opportunity to think beyond just a single health plan partnership? These enablers can support the aggregation of all risks on behalf of not just one provider organization, but multiple in a community or region.”
Enablers can also reduce or eliminate downside risk for risk-averse providers, while also accelerating cash incentives, Haugen said.
How Signify leverages the home
According to Signify, 29% of Medicare members return to their primary care physician (PCP) within 30 days after their in-home health evaluation.
Although these in-home evaluations shouldn’t be seen as substitutes for a visit with a PCP, they can lead to crucial findings in a member’s health journey.
“It does, in fact, support those relationships and helps drive patients to primary care,” Denise Graeber, senior vice president of product management at Signify Health, said during the webinar. “When we think about in-home evaluations, they have historically been targeted at Medicare Advantage members. The need and the value of in-home evaluations is continuing to grow.”
There is a substantial opportunity for providers and health plans to collaborate in order to reach some of the more “hidden” members that have specific needs.
For instance, Graeber pointed out that 11% of Medicare beneficiaries don’t have a PCP and 19% have a transportation need.
“That’s why referrals coming out of in-home evaluations are so critical,” she said. “That’s where we can connect immediately to emergency care, but also to help with care coordination. Whether it’s back to a primary care physician, a specialist, a care gap closure or a testing follow-up appointment.”
In-home visits can also lead to home-based care referrals, whether to personal home care providers or Medicare-certified home health providers.
“The value of the in-home visit is unlike your more traditional visit with a doctor in the health care setting,” Graeber said. “There are things that you see and hear at someone’s dining room table or on their couch that don’t get anywhere else. You really start to understand, on a deeper level, things like medication adherence, hazards around the home and other barriers that might exist that are impacting mobility and — therefore — overall health.”
At Signify, the integration following in-home visits is already showing promising results.
In a recent case study, Signify reached back out to members after an in-home visit. Of those that Signify contacted, 20% of members were interested in learning more about Signify Health.
Of those members, 50% scheduled an appointment during their first call with the provider partner.