‘Do The Homework’: What Home Health Providers Need To Know Before Sitting Down With Payers

Home Health Care News | By Patrick Filibin
 
Diving into value-based arrangements with payers always sounds good, in theory, for home health providers.
 
But it is easier said than done. Providers have to commit to value-based care, but even before that, they need to do their homework to be successful over the long haul.
 
Moving away from fee-for-service and moving toward risk through value-based arrangements takes a tremendous amount of research, operational awareness and financial investment.
 
It also requires legwork before, during and after negotiations with payers.
 
“In my experience, what happens so often is that providers get brought into these conversations without doing their homework first,” Fred Bentley, managing director at ATI Advisory, told Home Health Care News. “All of a sudden, they’re at the table and they think, ‘Let’s wing it.’ Or they will let the payer dictate the conversation, and the provider is just in reaction mode.”
 
What providers can do
 
Before sitting down at the table with payers, providers should clearly understand their goals. It may seem like a no-brainer, Bentley said, but it’s often an overlooked aspect of the process.
“It sounds so obvious, but ask yourself, ‘As a home health provider, what are we trying to achieve here?’” Bentley said. “There are different objectives. It can split into two paths: are you looking to grow your core business and are you using value-based care as a tool to be a more preferred critical partner in the eyes of the payer? And, it’s not mutually exclusive, but on the flip side, do you see real revenue upside?”
 
It’s quantitative versus qualitative, Nick Seabrook, managing principal at SimiTree, told HHCN.
“What do you want to get out of this?” Seabrook said. “You can get into it from a dollar and cents standpoint — prioritizing revenue. Or you can get into it with almost a marketing approach and say, ‘We have this relationship with a certain payer because we’re succeeding in this,’ and that could open the door to other referral sources.”
 
Also in order: a brutally honest look at what a provider’s value proposition is.
 
One of the challenges home health faces in particular, Bentley said, is that they are late to the game.
 
“They’re not out of the picture, but it’s not uncommon for payers to say, ‘We empower the primary care doctors and shift the risk to them — what can home health bring to the table?’” Bentley said. “That’s when you find your value prop — providers should have a painfully honest discussion about what they could bring to a Humana, for instance. What is it that you bring to the table, and how do you convince them that you’re ready for this?”…

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