MD Home Health — one of the largest providers in Arizona — has worked to establish itself as the “care for everyone” company, embracing payer agnosticism.

Currently, the company’s payer mix is around 20% Medicare and 80% non-Medicare, as in Medicare Advantage (MA), private insurers and others.

“I just think of the things that every other agency, when I ran them, declined,” Joseph Furtado, administrator of MD Home Health, told Home Health Care News. “‘Oh, we don’t do workers comp. We don’t do personal injury. We don’t do letters of agreement.’ That’s our bread and butter, we do everything. It’s not, ‘What is their payer?’ It’s, ‘How can we help everyone in the community?’”

MD Home Health is a privately-owned Phoenix-based provider that offers traditional skilled services in the home, as well as specialty programs and non-medical personal care services through its MD Home Assist arm. Recently, the company added hospice to its service lines.

Cementing itself as a company that isn’t exclusively tied to Medicare means that MD Home Health has also actively sought out MA opportunities.

The company’s rehospitalization rates have been one of the key strategies to landing MA contracts.

“Our rehospitalization numbers are less than 10%, we’re in the single digits,” Furtado said. “I show that to a payer, to [demonstrate] how I’m saving them money. I’m asking for $5 or $10 more a visit. Some of them see that and agree with us, and some don’t. The ones that will, are the ones I try to work, within reason. The economics have to make sense.”

Furtado refers to this as a delicate balancing act. This has sometimes meant recognizIng that not every opportunity is the right one.

“One of the things I also say is, I’m not going to make every payer be able to work for me, and that’s okay,” he said. “Another agency may have a better relationship with them.”

Value-based care is another priority for MD Home Health. The company has entered these arrangements through working with local hospital systems. Furtado believes that finding the right partner is crucial.

“It’s one-on-one, you’ve got to find a willing partner,” he said. “I’ve heard horror stories from people who enter into some of these shared risk value-based arrangements, and it ends up being a financial disaster for their company. You’ve got to start small, you’ve got to pilot the program, make sure it works for both people.”

MD Home Health has found the most success by shifting conversations with potential partners away from money, and instead presenting the company as a solution.

“We ask, ‘What’s your pain point?’” Furtado said. “‘What are you guys having a problem with? I am a solution. I’m here to help.’ When you reframe the conversation away from ‘I need more money’ to, ‘What’s your problem, and how can I help you with your problem,’ it’s a whole different conversation. Now we’re getting solution-focused, and the conversation starts making sense. It’s working for both people.”

Like its home health peers, MD Home Health also participates in value-based care through the Home Health Value-Based Purchasing (HHVBP) Model.

Since the company operates in Arizona, one of HHVBP’s original pilot states, MD Home Health has 10 years of experience with the model.

Still, Furtado pointed out that the model has become much more complex compared to its early days.

“Take [HHVBP] into small bite-sized pieces,” he said. “Teach it to your staff. It’s getting everyone to understand that the focus of it all is getting our patients better than they were when they got to us. Every department — your QA, scheduling — it all has to be aligned. They all have to understand the vision. The vision can’t just be making money and getting more patients.”

Overall, figuring out how to help everyone coming out of hospitals, regardless of payer, is MD Home Health’s ultimate goal.

For Furtado, this means incorporating a charity component into the organization. MD Home Health has already taken small steps towards this larger aim.

“We’ve worked with some of the local hospital systems when they have a charity patient in the hospital, who needs to go home,” he said. “They will reach out to us, and say ‘Hey, we have this patient and their wounds are almost healed. We need you to now take the reins, as the charity payer for this.’ It’s kind of like a community ACO where we’re all working together, as payers and providers, to take care of everybody.”