Over the years, home health and in-home care providers, as well as others in the post-acute sector, have been denied seats at the larger health care continuum table.
While some progress has been made as consumers increasingly seek care at home, a large gap remains, primarily between payers and post-acute providers. The source is a lack of two-way communication and, therefore, opportunities to educate each other and collaborate.
Payers are left without a full understanding of the services and impact that home health and in-home care providers deliver. This leads to lower reimbursement rates and funding opportunities that ultimately limit the potential of high-quality care and experiences for the patient or client.
Worse, by not closing this gap, the post-acute sector risks facing federal budget reductions, as evidenced by the Centers for Medicare & Medicaid Services’ (CMS) recently proposed cuts to home health payments. In-home personal care has yet to be recognized by CMS’ star rating system, and home medical equipment providers are still fighting to be reimbursed appropriately.
The opportunity to begin mitigating these risks by building payer relationships is right in front of us—and the time to capitalize is now.
When discussing the importance of payer and provider collaboration during a recent Forcura event, Wanda Coley, vice president of strategy at UnitedHealth Group, said, “Our [shared] goal is to make navigating the health care system easier and to improve the outcomes and to have quality care for patients.”
The post-acute sector must be proactive and create opportunities to come together with payers to achieve our common goal. The key to building those payer relationships is identifying alternative approaches to measuring your value as a provider and the impact you have on your patients or clients, and then communicating with payers and educating them about that value.
“It’s about articulating what value you are bringing to the table, and particularly if you’re filling a gap that’s out there in the health care system … bring it to the table and share it,” Coley said. “When we align in that way … the incentives start to line up as well.”
Being at Your Best = Being Interoperable
The most effective way to prove your value to payers is by identifying the quantifiable impact of the services and impact you deliver both for patients or clients and for all of the players across the care continuum.
Maximizing that value means achieving interoperability. At its core, interoperability is deploying technology and methods that enable the efficient exchange of information and data among different entities. When properly at work in health care, interoperability allows acute and post-acute providers to share patient documentation, process referrals and much more in an efficient and timely manner.
This fosters a variety of benefits for providers. You’ll experience stronger compliance, leaner and more profitable operations, and, ultimately, a smoother care experience for patients who are discharging from the hospital and receiving episodic or ongoing care at home.
It also supports staff satisfaction and retention, as employees will spend less time on administrative tasks such as sending faxes and gathering physician signatures, enabling a shift to more strategic, productive and fulfilling roles.
Interoperability also allows providers to generate quantifiable data that measures efficiency, impact and value in ways that weren’t previously possible.
When presented properly, this exchange of data and cross-sector collaboration gives payers a stronger understanding of provider services and their impact—which encourages them to appropriately reimburse based on data and fact.
Ultimately, interoperability creates an environment of connected care that leads to better performance across the entire health care continuum.
Leveraging Technology to Achieve Interoperability
True interoperability is possible only with the right technology and approach. You must leverage the technology systems that align with your services and compliance requirements and that can integrate into your operations.
For example, it’s critical to ensure that your organization’s technology can talk to other systems, especially electronic health record systems and referral sources. You must have the capability to transfer and receive sensitive medical information, data and files electronically, from almost any source.
Further, the systems and methods you deploy must reduce workload for staff rather than creating more of it. The tools and approach you implement must generate more automation and avoid increasing unnecessary processes that simply lead to more headaches.
And finally, it’s important you have the capability to extract analytics and data so you can identify quantifiable metrics that will help you report on your performance and articulate the value you provide or the gaps you fill.
Metrics to Extract & Report
When you become interoperable as a provider, the opportunities for establishing metrics that tell your value story are vast. What’s first important is identifying characteristics of your services and operations that are quantifiable in nature and are relevant to the payer audience.
For example, reporting on your agency’s ability to onboard a new patient communicates to a payer how quickly and efficiently you can move a patient from the hospital to a home setting. Metrics to consider may include the volume of referrals and the average speed at which you are accepting them. Also consider tracking the ratio of your back-office staff to referrals created daily as a measure of your internal efficiency.
Next, don’t overlook the importance of staff retention, especially in today’s economy. While not a direct correlation to profitability, communicating a strong year-to-year retention rate indicates a more sustainable operation where less investment in training and hiring is required and quality of care could be higher.
And finally, identify how the payers you want to partner with are measuring their success with patient outcomes, cost savings and more. Match your services to those metrics as evidence of your value and discuss how you can create common metrics against those goals.
Closing the Gap Between Payers & Providers
Creating common ground between payers and providers won’t happen overnight—it’s more of a marathon in which education and relationship building is key. But the longer we wait, the more risk we face in regard to receiving lower reimbursements and even reductions in federal funding.
Providers must start by building toward interoperability and telling their value story in different and creative ways.
Don’t wait until it’s all perfect, either. Determine what you do well and where you can improve. Share your strengths with payers as well as what you are working on in the short and long term. And invest in the right tools that help you improve and become interoperable with others.
By quantifying your impact beyond the number of stars you receive, you form a more tangible and powerful argument on why in-home care is a necessary and instrumental part of the health care continuum.