Home health providers may walk away from specific health plans due to financial feasibility, administrative burdens, or misalignment with their patient care values and priorities. However, this decision can create short-term challenges with referral partners and health systems, as they may have patients enrolled in those plans.

“If a health plan consistently under-reimburses for services or requires excessive administrative hurdles, it may compromise the ability to deliver quality care efficiently,” Preston Lucas, chief financial officer at Interim HealthCare Great Lakes, told Home Health Care News. “Additionally, if the plan’s policies restrict access to necessary treatments or fail to support the level of care required for patients, it becomes difficult to sustain the partnership.”

Founded in 1966, Interim HealthCare provides home health care, personal care and support, hospice care and medical staffing services. The Sunrise, Florida-based franchise network comprises 320 individually owned and operated offices.

Interim HealthCare Great Lakes operates in the Midwest and in Florida.

Medicare Advantage (MA) plans often pay meager rates for home health services. Particularly as the Centers for Medicare & Medicaid Services (CMS) reduces traditional Medicare rates, that puts providers’ business sustainability in danger.

Maintaining open lines of communication and emphasizing the shared goal of providing high-quality care helps mitigate the short-term consequences of leaving a health system, according to Lucas.

By explaining the rationale – such as unsustainable reimbursement rates or obstacles to patient care – most partners understand the need for such decisions. Ultimately, prioritizing the best patient outcomes resonates with referral partners.

“Transparency and collaboration are key,” Lucas said. “When communicating such decisions, engaging referral partners early in the process is important. This includes explaining the reasons behind the decision and offering supporting data. Above all, focusing on how the decision aligns with patient care priorities ensures the conversation remains constructive.”

To maintain trust, it is essential to demonstrate continued commitment to shared goals, he said. This can include offering alternative pathways for collaboration, ensuring seamless transitions for affected patients and remaining accessible for ongoing discussions.

Demonstrating flexibility, such as working with other health plans or exploring innovative care models, also helps reassure referral partners of your organization’s dedication to quality and collaboration, Lucas said.

“The main challenges include addressing misunderstandings about the rationale behind the decision and navigating operation disruptions,” he said. “Referral partners may initially feel frustrated if the decision impacts their workflows or patient care pathways. To overcome these challenges, it is critical to maintain proactive communication, offer solutions to minimize disruptions and demonstrate consistent commitment to collaboration and high standards of care. We also assist our referral partners with placement for clients when we cannot accept due to the patient’s health plan.”