Referrals are home health providers’ “lifeblood” – but the referral landscape has become increasingly challenging, requiring providers to restrategize and differentiate themselves.

To thrive in a rapidly evolving referral landscape, including the rise of Medicare Advantage and reimbursement pressures, providers are forced to accept different patient populations and find ways to stand out to potential referral partners.

The referral landscape has transformed, in part, through increased automation that drives referrals to specific providers, according to Rexanne Domico, president and CEO of Interim HealthCare. Overall, it’s become more difficult for providers to forge relationships.

“The biggest obstacle in a lot of places, if you’re looking for volume referrals, is access,” Domico said at Home Health Care News’ FUTURE conference. “Getting into hospitals has gotten a lot harder. Working in any of your facilities is a little tougher than it used to be. But I do think that there is still a lot of room for really good data back to referral sources and also sound relationships with people you have the opportunity to work with and help make a difference.”

Sunrise, Florida-based Interim HealthCare operates over 300 franchise locations across the U.S., offering home health, senior care, hospice, palliative care, pediatric care and medical staffing services. Its franchises provide 25 million hours of home care to 190,000 individuals each year.

While building relationships with referral partners, providers are also wary of changing tides affecting the home-based care industry overall, which require them to renegotiate their referral strategies while considering industry-shaking pressures.

“We are all competing for attention, for five minutes – if we can even get in the hospital – to just get them to say yes to working with us,” Brent Korte, CEO of Frontpoint Health, said. “It’s a different environment, and it’s evolving a ton. The fact that we’re competing for Medicare patients with a 6% cut coming, it’s even a bit more ominous.”

Cimarron Healthcare Capital and Tacoma Holdings-backed Frontpoint Health provides home health, hospice, palliative care and personal care services across 176 counties in Texas.

Strategies to build trust and differentiate

To stand out to referral partners, providers must stand out from their peers and demonstrate their value. The key elements of building a referral relationship include fostering trust and achieving low readmission rates, according to Korte.

Additionally, success in the current referral landscape requires an element of episodic care.

“Referrers say, ‘Don’t cherry pick,’” Korte said. “But the truth is, we have to have episodic care, or we can’t be in business. Even our company, which is built on Medicare Advantage, we have to have some level of episodic care. So what we do is try to say yes and do that in such a way that everyone we work with … says ‘They’re actually adding value to me and to my day.’”

Saying yes to patients is critical for Linden, Tennessee-based Perry County Home Health, according to CEO Matt Sevier.

“Even if I have to say no to a patient, I want to provide some immediate alternative so the case manager knows what to do instead of having to call another provider, so they see you as the resource for [knowing a] patient can be placed,” Sevier said.

Perry County Home Health provides in-home nursing and physical therapy in Perry County, Tennessee. 

Start-of-care speed is one way providers can stand out – though goals like initiating care within 24 hours are not always realistic or even preferred by the patient, according to Domico. Managed care patients now usually start care in about three days, she said, and traditional Medicare patients typically begin care in two days. Providers that can initiate care faster than that will have an edge over their competitors.

“Figure out what makes you really special in your market,” Domico said. “Figure out how you put efficiency and technology around that if you can, and then talk about it all the time.”

Providers must also stand out in their communication with referral partners. In addition to executing the things providers tell their partners they will do, providers must also communicate when there is an issue with a patient. The most important call a provider makes to their referral partners, Domico said, is the one in which a provider must apologize and tell their partners that something did not go well with a patient.

“Those calls are hard to do, but incredibly effective,” she said. “We do work in a business where things don’t always go exactly the way we think they’re going to go. Or maybe they never opened the door, or maybe they never were there when we said we were going to be there. Just getting in front of those things is also incredibly important.”

The future of the home health referral relationship

As providers seek to stand out from competitors and strategize ways to forge and maintain referral partnerships, they are also preparing for key trends.

Providers must cope with the trend of home health being undervalued, Korte said. Home health providers have become seen almost like vendors, Sevier said, limiting access.

Additionally, all providers, regardless of size, must prepare for the proliferation of Medicare Advantage, Korte said. If providers focus solely on the remaining traditional Medicare patients, they will find those patients are increasingly out of reach.

“The tidal wave is 100% coming,” he said about Medicare Advantage. “Are we going to surf it? Are we going to let it go right over us? If you’re not prepared, and if the strategy is just, take the remaining Medicare, [those] apples are going to be out of reach soon.”

Despite its slim reimbursement margins, Sevier is leaning into the Medicare Advantage trend and said he prefers accepting it over traditional Medicare.

“The idea is that when you’re in an area with less competition, it’s not fierce,” Sevier said. “You don’t have sharks in the water. With traditional Medicare [you compete with] sharks because everybody is vying for this piece of pie that just keeps getting smaller and smaller and smaller. So with Medicare Advantage, I don’t have that problem. You have fewer people trying to get an increasing number of patients.”

While adjusting to changing trends, home health care providers must stay laser-focused on improving their processes to maintain referral relationships.

“It’s incredibly important that you think about how you can do all of this better,” Domico said. “How can you get people through the referral process quicker, more efficiently, and then be able to give factual information about how those people are doing? Because your referral sources are going to care about that, your payer sources are going to care about that.”