‘They’re David Without The Slingshot’: How Small Home Health Providers Can Gear Up For MA Negotiations

Home Health Care News / By Patrick Filbin
Getting to the negotiating table with Medicare Advantage (MA) plans and coming away with a good deal is tough enough for even the biggest players in home health care.
For smaller providers, it’s an even more daunting and intimidating task.
However, there are steps those smaller providers can take in order to become more attractive and valuable managed care organizations.
“I think the biggest challenge that providers have is they don’t have the data to show what they’re truly doing,” McBee Associates President Mike Dordick told Home Health Care News. “Providers need to be able to show value. There are plenty of agencies out there that can do the work — and some that’ll take low rates. But in order to get to the table, regardless of size, you need to be able to show your readmission rates, show that you have superior data and show that you have programs that no one else has.”
McBee Associates is a consulting firm that works with hospital, home health, hospice and skilled nursing clients.
Smaller home health providers are at a natural disadvantage when it comes to getting those more preferable MA contracts. It’s difficult for them to carve a path for themselves in concentrated markets where larger providers have significant footprints.
That’s where the proof of value becomes even more paramount.
“We’re focused on mining the data and understanding what the insurance companies want,” 
Continuous Home Care CEO Will Putman told HHCN. “One big thing is hospitalization rates. Another is getting care started on time — the initiation of care. Recently, we’ve seen a big push on transition of care appointments, so we’re making sure our nurses are helping facilitate that. Then it’s all about taking that data back to the insurance companies to show the value we provide them.”
Continuous Home Care is a Pennsylvania-based home health provider with about 350 employees. Today, the company’s revenue breakdown is about 40% traditional Medicare and 60% MA.
When negotiating with MA plans, Putman puts an emphasis on benchmarks and makes an assessment on whether Continuous could be a good partner.
“If we can keep the hospitalizations down, if we can show them that we can hit their benchmarks, then it becomes easier for us at the negotiating table,” Putman said. “If we can say we can provide good, quality care, can be done in less than 30 days and maybe in seven or eight visits instead of 12 or 15? Then we’re getting somewhere. Because then, not only are these payers getting quality care, it’s a cheaper value for these managed care insurers.”
Managed care companies obviously care about cost, Dordick said, but outcomes are as important as value-based care proliferates.
Unique, value-based programs in concentrated markets could be an avenue of success for smaller providers who have the ability to pivot easier.
“If you can show you’re providing better value than your competitors, that’ll give you a better chance for a seat at the table,” Dordick said. “The small providers have the ability to be more nimble, but they need the data to show why. Even with all of that, that doesn’t mean they’re going to get a seat at the table. But it gives you a chance.”
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