NAHC Merger with NHPCO on Track for Implementation Next Year, Leaders Say

McKnight’s Home Care / By Adam Healy

The National Association for Home Care & Hospice (NAHC) plans to finalize its merger with the National Hospice and Palliative Care Organization (NHPCO) by the end of the year, leaders revealed Sunday at NAHC’s Home Care and Hospice Conference and Expo 2023.

“One plus one equals three,” Bill Dombi, president of NAHC, said at the event’s general session, emphasizing the strength and reach that the organizations hope to achieve by merging. “It’s also one plus one equals one. This is not to maintain two organizations under an umbrella. This aims to create one single organization integrated from top to bottom, with recognition that health care at home is a broad breadth of services that we’re there to represent.”

The search for a chief executive officer is scheduled to begin around November or December, Ken Albert, board chair at NAHC, noted. By the end of the year, NAHC and NHPCO hope to have signed definitive agreements. Beginning July 2024, they will begin “dual operations,” Albert said, a transitional period wherein the organizations will still operate independently.

“That’s the plan, and you all know how the best laid plans go, right?” joked Albert. “That’s what we have on paper and in our minds.”

By merging, NAHC and NHPCO are hoping to achieve greater collaboration and influence. Dombi and Albert stressed that a unified voice will be critical for home healthcare’s future success, especially in the face of challenges such as workforce shortages and Medicare rate cuts that may be finalized in the coming weeks.

“We have got to unify the sector of healthcare home under a one voice banner on the Hill and in the state capitol,” Albert said. “We’re looking towards the future. What are we going to need as an association for our members — five years and 10 years down the road? Let’s build that together now. And so it’s been an exciting process,” Albert said.

New Research: Top Ratings for Home Healthcare Translate to High-Quality Care

Syracuse University / By Ellen Mbuge
 
New research from Syracuse University assistant professor Jun Li looks at whether the ratings for home healthcare companies correspond with quality patient care.
 
Li, a health economist who is part of the public administration and international affairs department in the Maxwell School of Citizenship and Public Affairs, wanted to see if Medicare’s Quality of Patient Care home health star ratings have an impact on patient care.
 
Critics have argued that these ratings are inaccurate. But since Medicare’s ratings provide the only source of systematically and publicly available information on home health agency quality, it is important for patients to have access to valid ratings in order to find high-quality care.
 
In the paper “Home Health Agencies With High Quality of Patient Care Star Ratings Reduced Short-term Hospitalization Rates and Increased Days Independently at Home” and published in the journal Medical Care, Li studied more than 1.8 million Medicare fee-for-service beneficiaries who used home health care from July 2015 to July 2016 in the United States and evaluated whether patients treated by higher-rate agencies had better health outcomes.
 
Li looked at how many days patients were able to live independently at home after receiving home health care as well as if they needed hospitalization, visited an emergency department, had to be institutionalized, or died in the short-term.
 
In the study, Li found that patients treated by higher-rate agencies did better both in the short-term and long-term outcomes.
 
“Rates of hospitalization, emergency department use, institutionalization generally decreased,” said Li. “Patients treated by higher-rate agencies spent more time at home.”
 
With these findings, policymakers should work to increase awareness and use of the ratings by patients and their caregivers said Li.
 
The star rating was created in 2015 with the aim of distinguishing high from low-quality home health agencies. Home health care plays an important role in caring for the elderly. For both the government and patients, Medicare’s home health visits are one of the least expensive ways to provide care, but assessing quality is often challenging for patients and their doctors, who must select an agency, often just as patients are leaving the hospital. Furthermore, many people tend to be less familiar with the reputation of home health agencies than they are with hospitals and other institutions within their communities.
 
While the rating system works, there are still issues with patients in rural areas who don’t live 
near highly-rated agencies.
 
“While this study shows that the rating systems helps connect patients with effective home health agencies, there are still issues for some patients in accessing high-quality home health care, especially in rural settings,” said Li. “For example, 15% of patients live in zip codes where the best-rated home health options was only average. Knowing that the star ratings provide valuable signals of quality only means that we need to work harder at making sure that all people have access to high-quality care.”

Senate Finance Targets Medicare Advantage Brokers

Stat News / By John Wilkerson
 
Senate Finance Committee members from both parties took aim Wednesday at insurance brokers that sell plans for large Medicare Advantage insurers.
 
Older adults at times have more than 100 plan options, and brokers help them choose the right one. But brokers can be incentivized by large insurance companies to aggressively sell plans that are a poor fit for the Medicare beneficiaries they’re supposed to help. Brokers also sometimes collect private information that they sell to multiple insurance companies. Those brokers tend to have a national scope, just like the large insurers they represent, compared to the independent, local brokers.
 
“They are big private marketing companies in the middle between seniors and their coverage,” Chairman Ron Wyden (D-Ore.) said.
 
There were two main goals of the hearing: to protect seniors and disabled beneficiaries from unscrupulous marketing tactics, and to give small insurance companies a level playing field to compete with large, national insurers.
 
Wyden released a report a year ago that highlighted the aggressive marketing practices that brokers sometimes use, and he said he plans to investigate more.
 
At the heart of the problem is the large amount of money that big insurers pay brokers for 
enrolling seniors in their plans, according to Krista Hoglund, CEO of Security Health Plan in Wisconsin. Medicare places a $611 cap on the commission that brokers can earn from enrolling a beneficiary into a Medicare Advantage plan, but large insurers often pay additional fees to brokers that can add up to more than $1,300.
 
To sell those plans, brokers flood seniors with phone calls and marketing materials that misrepresent the value of those plans. One tactic, which Wyden called “ghost networks,” involves promising older adults access to providers who aren’t taking new beneficiaries. Brokers will even sometimes switch seniors from one plan to the next without the beneficiary’s knowledge, Hoglund said.
 
Hoglund recommended making insurers and brokers disclose how much brokers are paid to sell plans. Once Medicare has that information, it should standardize and limit broker compensation.

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What Home Health Providers Are Learning From HHVBP’s First Full Year

Home Health Care News / By Patrick Filbin
 
In the midst of the first full performance year for the expanded Home Health Value-Based Purchasing (HHVBP) model, providers are figuring out where they are succeeding and where there is room for improvement.
 
HHVBP continues to save hundreds of millions of dollars each year, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
 
And the initial set of HHVBP scores — on the provider side — is influencing the operations of home health providers of all sizes.
 
“We are steering the entire company towards value outcomes,” Ananth Mohan, COO of Elara Caring, told Home Health Care News. “It adds to the complexity of how we do business, so you have to be sophisticated about it. With the midway point scores, it’s really geared us up and reaffirms that this is the way the world’s going to go.”
 
HHVBP scores
 
The HHVBP model, which CMS expanded from nine demonstration states to home health agencies across the country on Jan. 1, 2023, was implemented to incentivize home health agencies to improve the quality of care they provide to Medicare beneficiaries.
 
The goal of the model is to link Medicare reimbursement to the quality of care, rather than just the quantity or volume of services.
 
The way CMS does that is through quality measures and performance scoring. Those measures include patient outcomes, patient experience, process measures and timely initiation of care.
 
Each category has specific measures that contribute to the overall performance score. The performance period usually lasts a year. During that time, CMS evaluates the data that providers share, and, from that, a score is returned to providers that can negatively or positively affect their reimbursement.
 
After reviewing the scores Elara Caring received at the six-month point, Mohan is pleased with the early results. In particular, Mohan is encouraged in how the results have affected day-to-day operations.
 
“On the hospitalization front, the results made us think about being more programmatic,” he said. “It changed how we think about centers of excellence around certain diseases, how we think about which areas of the company where we’re more hospital-heavy. It’s also changed the way we think about things like remote patient monitoring. RPM is not incentivized today, so you’re essentially giving it away. But if you’re giving it away in this mode,l then it matters, because it drives outcomes.”
 
The Dallas-based Elara Caring is one of the largest home health, home care and hospice providers in the country, with about 200 locations across 17 states.
 
The HHVBP model has given Elara Caring insights into what is working and what isn’t working at different locations.
 
For instance, the midpoint check-in has reinforced the need for predictive tools.
 
“Otherwise, we’re always just looking backward,” Mohan said. “So, we built an in-house, custom predictive tool that our branches are able to use and see on a real-time basis what they’re good at and what they need to improve on. I continue to be impressed at how this resonates culturally with people. If you give them the right tools, they can make an impact. We’re seeing that.”
 
On the flip side, the early results have shown that reducing hospitalizations will be a “never-ending challenge.”
 
For patient satisfaction and OASIS scores, the simplified strategy is to see where improvements need to be made and to stay on top of them. For clinically-driven results, it’s a tricker task.

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