The relationship between Medicare Advantage plans and home health care agencies has not changed much over the last few years.
They are often filled with bitterness, yet and lack communication.
What has changed is how vocal home health providers have been about the issue. Providers went from shying away from the topic, to discussing it on background, to taking the microphone and more or less rallying their peers to fight back.
And they feel they need to fight back because MA plans pay far lower rates for home health care than fee-for-service Medicare does.
On Wednesday, another step was added to the MA-home health saga, however, as we got to hear from the other side – on the record – for the first time in a while.
“Payers have star ratings too, just like in home health,” Wanda Coley, the VP of strategy and execution at UnitedHealth Group (NYSE: UNH), said on a webinar hosted by Forcura. “We live and breathe that every day. It’s publicly reported information. It’s our scorecard on how well we’re doing. [But] There’s these gaps and opportunities for education, and there are conversations that need to happen.”
UnitedHealth Group is one of the largest payers in the entire country. Optum – a subsidiary of the company – is in the process of acquiring one of the largest home health providers in the entire country, LHC Group (Nasdaq: LHCG).
Providers in the field have told Home Health Care News differing opinions on that deal and what it may do for the home health industry and its fight for more fair rates. Some believe having LHC Group in house as an ally will be beneficial, and others aren’t so sure.
Coley can be considered an ally to the industry, however, due to her background. Before she joined UnitedHealth Group, she was the president and COO of Well Care Home Health, a provider based in Wilmington, North Carolina.
“From the payer side to the provider side – particularly more on the post-acute side – I think there’s an opportunity for education,” Coley said. “We’re doing some of the same work and there’s an opportunity there to align. There’s duplication, which then drops costs … it goes back to interoperability and how we share this information across the different care settings.”
So although things haven’t changed too much over the last couple of years, especially when it comes to fairer rates – providers have reported getting as much as 50% less pay from MA plans for their services – an open dialogue between the two could be a good first step.
Jared Hanson, the VP of corporate strategy at CenterWell Home Health – formerly Kindred at Home – expressed the same sentiment on the webinar.
Similar to LHC Group, Kindred at Home was acquired by Humana Inc. (NYSE: HUM), another one of the largest payers in the country.
“You can already see the combination of payer and provider coming together and speaking with more common language,” Hanson said. “It can be a very similar approach [from each side], but that’s good. That means that we’re having dialogues and making progress, right? One of the things that’s important is that both payers and providers care deeply about their patients and members. You have that you have that foundation … to find the right care at the right time. The KPIs are similar.”
Medicare Advantage plans have been under increased scrutiny of late, with House lawmakers pushing for more oversight of plans in light of concerns over higher spending, improper claim denials and access to treatment.
That has both satisfied providers who felt MA was the federal government’s “darling” of late, and also drawn more ire from providers who feel they are still getting the short end of the stick.
The role of home health care in MA
One of the key reasons that home health care is still undervalued among MA plans is a lack of awareness over what home health care can provide for patients in the believe long run, insiders.
A 2021 report on the role of home health care in MA from the Research Institute for Home Care found that there “remains a need for a better understanding of the value of home health in MA.”
In addition to increased communication, there needs to be more research on home health and its possible benefits to MA, and perhaps where providers and payers can meet in the middle.
“Interviews revealed that this kind of lack of understanding may even be there with Medicare Advantage plans, who don’t really seem to understand entirely what home health care entails,” Elizabeth Hamlett, a senior research associate for KNG Healthcare Consulting, said. “One interview pointed out that Medicare Advantage plans believed that home health care was limited community-based care, which is still very important, but different from skilled home health care.”
KNG Healthcare Consulting teams up with the Research Institute for Home Care on the report.
“As a result of that lack of information, there’s kind of an access issue,” Hamlett continued.
That could also undoubtedly lead to a payment issue.
And in order to get past that, providers and payers likely will need to do two things: be vulnerable with each other enough to share data and also communicate at a much higher clip.
“We can do a much better job at communicating,” Coley said, “And the gap is oftentimes when there’s conversation between a payer and provider around contracts and negotiating rates, right? And I think we have to take it a step further to also say, ‘Yeah, well, let’s talk about that piece. But let’s also talk about what’s in your [provider’s] portfolio and about all you can [offer].”