Post-acute care has steadily moved toward value-based care and away from fee-for-service payment models. But despite the fact that this trend has been years in the making, many home health care providers still ask, “How do we get started?”
Executives from four different organizations focused on value-based, post-acute care explored that question Tuesday during a conversation at a webinar hosted by healthcare technology company Netsmart.
“If you’re starting out right now, partnering with another organization, especially payment providers, is a great place to start,” Devin Woodley, VNS Health’s vice president of managed care contracting, said during the panel. “We are empathetic with the supplier side. We understand what providers are looking for and where they are trying to go. Partnering with a payer or consultant is the best place to start in order to take those steps in the right direction.”
Headquartered in New York, VNS Health is one of the largest and oldest nonprofit home and community health care organizations in the US The company’s service offerings include home health care , hospice, personal care, palliative care services, mental health support and more.
In health care, the term “payer” refers to an organization that operates as both an insurer and a provider of services. Take Humana Inc. (NYSE: HUM), which has CenterWell and later its insurance arms, as an example.
About 25 years ago, VNS Health also created its own health plan. With over 35,000 members, it is now where most of the company’s revenue comes from.
By partnering with a payer like VNS Health, Woodley said providers can avoid many of the pitfalls that crop up in the early days of value-based contracting.
Finding the right value-based partner with similar expectations is another key component to establishing a value-based care presence, Amy Kaszak, Curana’s executive vice president of strategic initiatives, said during the webinar.
“Find a partner who meets you wherever you are [is also important] so your first step doesn’t have to be in the background,” Kaszak said. “There are more ways to do that today, like Medicare Advantage plans and smaller organizations focused on the populations they serve; That’s a great place to start.”
Curana’s multiple business segments include: a provider-led medical group, Curana Health Medical Group; AllyAlign Health Medicare Advantage health plans; and a Medicare Accountable Care Organization called Curana Health ACO.
Partnering with ACOs and primary care groups is another strategy that could carry fewer risks as providers dive into the value-based arena.
“You can take some risk of someone else’s risk and that might be a good baby step on this,” Kaszak said. “You can do this and participate in ACOs, often through groups of physicians that you’re already working with, so that you get the benefit of expanded primary care that will be important for you to take more risks in the future. Develop those relationships and maybe start down that risky path. [there].”
Rather than take risks by ensuring better clinical outcomes, Kaszak said providers can pivot and instead show health plans that they can capture value by having timely initiation of care and other benchmarks based on the performance.
“Even when you start working with a Medicare Advantage plan, joint ventures are great ways to get full ownership,” he said. “At the same time, not all vendors may be ready to do this, so starting with pay-for-performance or other small steps, perhaps working on process measures and not just results, is a good way to go. . ”
Data is also key, both for a vendor to demonstrate its own performance and for benchmarking against peers.
“What I would say is that they love math,” Bruce Greenstein, LHC Group’s chief strategy officer, also said during the webinar. “This is really an expression of data. You have to know your own data very, very well. The ones you will contract with will have many actuaries. They know your data. They know how much it costs and how much you can save. You have to think about what your value proposition is and how much you could save just with your own costs. So externally, what kind of cost can you save?”
If a vendor knows their numbers aren’t up to par with the market, it might be better to work things out internally before entering the value-based world.
“You have to know how you rank,” Greenstein said. “Are you a good provider? Do you end up in the bottom quartile against others for value-based purchases? If you’re underperforming, you may want to start working internally to become more disciplined and execute better before pursuing a value-based contract. If you are among the top vendors, then you really have something to sell.”
