Home care providers still expect payor fairness

Home care has taken on a bigger role in the broader health care continuum, but there are still challenges bubbling beneath the surface.

One of those challenges is the lack of payor fairness, John Kunysz, president and CEO of Intrepid USA Healthcare Services, said at Home Health Care News’ Capital+Strategy conference last month.

“I want payers to treat us all the same,” he said. “The games that paymasters play are mind-blowing in our industry. Normally, if we were a consumer, we wouldn’t put up with it. Our patients don’t know all these games that we play. We need to stop that and have that sense of fair treatment and fair payment processes.

Texas-based Intrepid USA has more than 60 locations in 17 states, making it one of the largest home healthcare providers in the United States, especially among those focusing on rural areas .

Kunysz noted that his past experience on the revenue cycle side has given him some perspective on the matter.

“I’m an ex-earning cycle person, so I know the method of refusing every ‘nth,'” he said. “What we’re finding now are some interesting flaws in the Medicare Advantage (MA) plans, where we go through the process and they deny and deny.”

This puts providers in a difficult position because even as an entity providing care services, they are not allowed to appeal such denials. This obligation is incumbent on the original referring doctor.

“Do you think the original referring doctor cares at all,” Kunysz said. “Are they going to give us time to help us refute this claim? No, they’re not, so payers are really adept at finding ways to stick with providers. It should be a true partnership with us to provide patient care in a more cost-effective setting.

Kunysz isn’t the only one feeling this.

Susan Ponder-Stansel, president and CEO of Alivia Care, says providers face the challenge of figuring out how to deliver the care consumers want — and achieve positive outcomes — while dealing with MA plans that currently have more weight than them.

“There’s this push from CMS to get out of the fee-for-service business and just push more into MA plans,” she said. “The challenge for us as providers is the asymmetry in that relationship, and the fact that the plans really look at the rate of medical loss – and how much of the 100 cents of every dollar they can keep.”

Alivia Care is a provider of home health, palliative care and personal care services. The company operates in 32 counties in northern Florida and southeast Georgia.

The challenges weigh heavily

Although home care managers are strategizing how to circumvent hidden challenges, the more well-known ones, such as staffing shortages, still loom large.

Like many industry peers, Alivia Care sees demand for care services, but the company doesn’t have enough staff on the personal care side.

Unlike other care facilities, personal care clients generally pay out of pocket.

“Since most [the clients] pay, … you can’t necessarily increase the cost like you would in other settings, because you’re going to eliminate a certain segment of your market each time you need to increase it,” she said. “It’s a big worry for me, how do we get the quality [caregivers] we need and maintain prices so customers can afford it.

At the same time, home care managers looking to attract new talent will need to consider their staff’s preferences in order to make the overall position more attractive, according to Kunysz.

“I talked about making this job cooler than being a barista at Starbucks, a Geek Squad member at Best Buy, or Apple Genius. … We have to let someone who is interested in musical theater deal with Robert Goulet or Julie Andrews,” he said.

Besides staffing and cost of services, another issue at Alivia Care has been ensuring that the home health segment of the business is ready for the nationwide expansion of the care model. home health value-based purchase (HHVBP).

For context, Alivia Care entered the home health market with the acquisition of Better Life Home Health in 2021.

“We bought an existing organization and then brought in great leaders who have only been in the home health business,” Ponder-Stansel said. “To start talking about value-based care and thinking about care planning, working from that care plan, medical and social work, all of these things that are really going to come into looking at our outcomes and how we align our results with the needs of the payer or referral source. It was a sore point.

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