LHC Group, VNS Health, Curana Execs On How To Take ‘Baby Steps’ Into Value-Based Care

Home Health Care News | By Patrick Filbin
 
Post-acute care has steadily been shifting toward value-based care and away from fee-for-service payment models. But despite the fact this trend is years in the making, many home health providers are still asking themselves, “How do we get started?”
 
Executives from four different post-acute and value-based care-focused organizations explored that question on Tuesday during a webinar conversation hosted by the health care technology company Netsmart.
 
“If you’re starting right now, partnering with another organization — especially the payviders — is a great place to start,” Devin Woodley, vice president of managed care contracting at VNS Health, said during the panel. “We’re empathetic towards the provider side. We understand what providers are looking for and where they’re trying to go. Partnering with a payvider or a consultant is the best place to start in order to take those steps in the right direction.”
 
The New York-based VNS Health is one of the largest and oldest nonprofit home- and community-based health care organizations in the U.S. The company’s service offerings include home health, hospice, personal care, palliative care services, mental health support and more.
 
In health care, the term “payvider” refers to an organization that operates both as an insurer and a provider of services. Take Humana Inc. (NYSE: HUM), which has CenterWell and then its insurer arms, as an example.
 
About 25 years ago, VNS Health also built out its own health plan. With over 35,000 members, it’s now where most of the company’s revenue comes from.
 
By partnering with a payvider like VNS Health, Woodley said providers can avoid a lot of the pitfalls that come in the early days of value-based contracting.
 
Finding the right value-based partner with similar expectations is another key component in establishing a presence in value-based care, Amy Kaszak, EVP of strategic initiatives at Curana, said during the webinar.
 
“Finding a partner that will meet you where you are [is also important] so your first step doesn’t have to be into the deep end,” Kaszak said. “There are more ways to do that today like Medicare Advantage plans and smaller organizations focused on the populations that you care for – that’s a great place to start.”

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The Top Legal, Regulatory Issues Home-Based Care Providers Are Facing In 2023

Home Health Care News | By Joyce Famakinwa
 
There are a number of key issues that home-based care providers looking to navigate legal and regulatory hurdles need to keep their eye on – some old, and some new. 
 
In some areas, it will be important for providers to increase their advocacy efforts, like when it comes to a potential ban on non-competes, Angelo Spinola, the chair of home care, home health and hospice at the law firm Polsinelli, told Home Health Care News.
 
“When the industry has pulled together, worked together, and spoken in a singular voice, that has been a very effective strategy,” he said.
 
A potential ban on non-competes is just one of the many issues providers need to prepare for. HHCN recently caught up with Spinola and Katy Barnett – director of home care and hospice operations and policy at LeadingAge – to get a complete overview nearly halfway into the year.
 
Increased government investigations into the home-based care industry
 
During the height of the COVID-19 pandemic, many home-based care providers relied on the financial lifeline of government relief programs.
 
Moving forward, home-based care providers should expect to receive more attention from government watchdogs, as those relief programs — such as the Paycheck Protection Program (PPP), the Economic Injury Disaster Loan (EIDL) and employee retention tax credit programs — receive more scrutiny, according to Spinola.
 
“There’s been a lot of investigation around qualifications to participate in those programs, the use of funds from those programs, and I think we can expect to see that trend continue,” he said.
 
An increase in investigations means that providers will need to be more proactive.
 
“Understand what the requirements are, and take proactive steps to be in compliance with those requirements before the government investigation,” Spinola said.
 
Specifically, it will be imperative for providers to perform self-audits and be able to trace how they’ve spent these funds.
 
Aside from providers’ use of the aforementioned program funds, there is also more investigation activity around anti-kickback issues and referral relationships.

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Here's How Lawmakers Can Slash Medicare Spending Without Cutting Benefits

Forbes | By Sally Pipes
 
Politicians don't agree on much these days, but one thing seems to bring even Democrats and Republicans together. And that's refusing to cut Medicare.
 
That position may be politically popular. But it's at odds with the long-term sustainability of the program. Medicare's hospital insurance trust fund is set to go bankrupt by 2028. The program costs taxpayers $747 billion each year—12% of total government spending.
 
Fortunately, there's a way for lawmakers to rein in Medicare spending without cutting benefits. By giving seniors vouchers to spend on privately managed Medicare plans, lawmakers can cut costs while increasing quality of care.
 
Such a model, which already works in one part of Medicare, will help keep seniors healthy while protecting Medicare for future generations.
 
About 35 million Americans were enrolled in "Traditional Medicare," a fee-for-service system that covers hospital insurance, Part A, and medical insurance, Part B. The federal government administers Traditional Medicare directly, paying out nearly every claim submitted—including about 8% of improper claims, which cost the government around $32 billion each year.
 
Shifting to a premium support model would rein in Medicare payments. The federal government would give each senior a voucher for a fixed amount of money that they could spend on privately administered insurance or Traditional Medicare.
 
In other words, insurers would have to compete for seniors' business. They'd have to assemble benefits packages that appeal to potential customers. Competition would drive down costs and improve quality. And that's good news for John Q. Taxpayer, who would ultimately be footing the bill.
 
According to the nonpartisan Congressional Budget Office, if lawmakers had shifted to a premium support model in 2022, Medicare spending could have fallen between $21 billion and $419 billion by 2026, depending on whether existing beneficiaries participated in the model.
Making the shift today would save beneficiaries $333 billion over a decade, and taxpayers $1.8 trillion over 10 years, according to former CBO director and current American Action Forum president Douglas Holtz-Eakin.

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Updated Resource Available: Introduction to the Hospice Quality Reporting Program (HQRP) Web-Based Training

The Introduction to the HQRP Web-Based Training is a two-part training series for Hospice providers.

Course 1: Getting Started with the HQRP and Public Reporting Provides a general overview of the HQRP and reviews the program’s use of three data sources: The Hospice Item Set (HIS), the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey, and the Medicare claims. Course 1 contains the following six lessons: 

• What is the HQRP?
• HIS and the HIS Manual
• Timing and Maintenance of the HIS
• HQRP Claims-Based Quality Measures
• The CAHPS® Hospice Survey
• Care Compare and Public Reporting

Course 2: HQRP Data Submissions and Reports Provides an introduction to the HQRP data submission requirements and reports available to providers. Course 2 contains the following six lessons:

• Getting Ready to Submit the HIS
• HIS Item Completion
• Successful Submission and Acceptance of the HIS
• Identifying and Addressing Errors on the FVR
• Overview of the HQRP Provider Reports
• HQRP Useful Websites and Resources

Although the course lessons were designed to be completed in sequential order, you may jump to any topic of interest. Each lesson can be completed at your own pace.

Links to web-based trainings:

• Course 1 – Getting Started with the Hospice Quality Reporting Program (HQRP) and Public Reporting
• Course 2 – Hospice Quality Reporting Program (HQRP) Data Submission and Reports

If you have questions regarding resources and training, please email the PAC Training Mailbox. Content-related questions should be submitted to [email protected].