Home-based Care Providers Go Beyond Chasing Contracts To Build Value-based Care Arrangements

Last week, Sue Chapman Moss, Kunu Kaushal and Bill Gammie were featured on the latest episode of HHCN+ TALKS, Home Health Care News’ live interview series for HHCN+ subscribers.

Throughout the episode, these leaders — representing Bayada Home Health Care, Senior Solutions and Kaiser Permanente — told me all about the various ways their organizations are engaging in value-based care arrangements, anticipating and navigating the biggest challenges associated with these opportunities, and so much more.

Moss, Kaushal and Gammie highlighted the importance of meaningful data, clinical innovation and strong partnerships to build value-based care agreements. Among their insights, a few were most top-of-mind for me. One of these is the type of relationship home-based care providers must build with payers to evolve their reimbursement strategies. Without strong connections, providers cannot glean the necessary information to determine what payers want – looking beyond just readmission data.

I am also keeping a close eye on the future of personal care in value-based care. The conversation revealed that, while much needs to change before personal care providers can become more involved in value-based care, trends are moving in the right direction. Personal care providers can look forward to a clear definition of value-based care that will cement their position in alternative payment arrangements. 

I believe that the knowledge gained from all three panelists offers a look at the current state of home-based care and value-based care, and the future of these kinds of arrangements.

In this week’s exclusive, members-only HHCN+ Update, I highlight this TALKS discussion and the standout themes that emerged in this conversation, such as:

– How home-based care providers can go beyond “chasing contracts”

– The allies providers must align with to truly gain value-based momentum

– Personal care needs to define what value-based care means for its industry

Chasing value-based care contracts

When I asked all of the panelists what some of the common errors home-based care providers were making when attempting to develop value-based care arrangements, Moss, managing director of payer and provider contracting and strategy at Bayada, and Kaushal, CEO of Senior Solutions, both pointed to a specific dynamic that can sometimes form between payers and providers.

“The mistake is really viewing payers as a transactional relationship,” Moss told me. “Our approach is definitely a partnership mindset.”

Bayada — a company that offers home health, home care, hospice and behavioral health care — has a host of value-based arrangements with payers. This includes Medicare Advantage plans, both nationally and regional plans, as well as a number of arrangements on the managed Medicaid side.

Bayada ensures that its partnerships with payers aren’t purely transactional by emphasizing alignment, transparency and real-time course correction. The company achieves this by remaining in constant communication with its partners.

“I think really having the partnership mindset is absolutely critical,” Moss said. “At the end of the day, I think the underlying theme here is underestimating, viewing it as the historical, antagonistic relationship, is a real barrier to success. Value-based care isn’t about a one-and-done contract. It’s a journey, and on that journey, definitely having the mindset of continuous improvement is really important.”

In the same vein, Kaushal noted the importance of home-based care providers understanding what their payer partners’ main interests are.

For example, while many payers care about hospital readmission, providers must obtain a more granular understanding of where the organization’s focus lies.

To get this understanding, home-based care providers must go beyond what Kaushal describes as just merely “chasing contracts.”

“There are deeper aspects or maybe a subpopulation that they’re really focused on,” Kaushal said. “I think having that relationship is enough to talk to them. I call it ‘chasing contracts,’ but if you’re chasing a contract because you know it exists, they’re not going to spell out the true intent behind it. You have to take that time to talk to them to understand.”

Brentwood, Tennessee-based Senior Solutions provides personal care services, transportation solutions and nutrition support. The company has a value-based contract with a managed care organization.

Senior Solutions and Bayada aren’t the only home-based care providers that are prioritizing value-based care arrangements.

HarmonyCares has been vocal about its participation in the Medicare Shared Savings Program (MSSP) and the Accountable Care Organization (ACO) REACH program. The company also partners with Medicare Advantage (MA) plans, specifically around their high-needs, frail populations.

“Value-based care really ties you to the outcomes for the patient, and also ties you to the bigger picture value creation that allows us to go out, and basically provide those services in the home,” Matt Chance, CEO of HarmonyCares, previously told Home Health Care News. “It’s an area we feel strongly about. It’s an area that we want to continue to advocate for, and protect, overall, as a place of service.”

As home-based care providers’ participation in value-based care becomes more common, I believe that leaders will be less focused on chasing contracts and will be more intentional about the way they approach these arrangements. Intentionality about these partnerships will become increasingly necessary for the evolution of value-based care in the space.

Home-based care providers also need alliances with key players that are working at these payer organizations.

“It could be the chief nursing officer,” Moss said. “It could be somebody in the quality department. It could be a chief medical officer. To bring them to the table early, I think, is really important because they will understand the value that you’re creating. We like to think about the fact that we’re the eyes and ears in the home.”

In my view, someone like Gammie, who serves as senior director of post-acute utilization at Kaiser Permanente, but has a home-based care background is ideal to forge such a relationship with.

“The ability to be part of home health, palliative hospice care and integrated delivery completely framed the reference point in coming to Kaiser and being able to … feel like a champion in my space to really have a unique ability to see both sides of the scenario,” he told me. “That’s helped me navigate communications at various levels in this organization.”

Before his time at Kaiser Permanente, Gammie served as executive director at Seasons Hospice and Palliative Care, a company that would eventually merge with AccentCare. He also served as SVP at Advantage Home Health Services.

These roles have also allowed Gammie to understand the constraints that home-based care providers are often faced with.

“Having that background and experience has helped me navigate those waters with more fluidity, with more focus, and really taking both the things that we need as an integrated delivery provider and the constraints and the opportunities that exist as delivering home health … We are expanding a lot of discussions in private-duty as well,” he said.

Personal care’s value-based care framework

When we think about value-based care in relation to home-based care, it’s natural to focus on home health, even in-home primary care.

This means that non-clinical home care, or personal care, is often left out of the conversation.

A few months back, at HHCN’s FUTURE conference, Kaushal pointed out that there isn’t a clear definition of value-based in personal care today, but that forming one will be necessary for providers to continue advancing.

“Most personal care agencies are not large enough, sophisticated enough, or ready to pilot a program that would be at-risk,” he told me during TALKS. “To me, there’s a lot of work to be done.”

While there tends to be less value-based care engagement from personal care providers, this doesn’t mean that agencies aren’t trying to carve out a space for themselves.

I think that Kaushal’s suggestion that personal care companies begin by piloting and testing out different value-based care arrangements will become crucial for home care providers looking to move where the puck is headed.

“Once that’s been established and there’s enough history and data, predictability, or at least game plans around that, I think the at-risk models may come,” he said.

Kaushal also views the Centers for Medicare & Medicaid Services’ (CMS) interest in personal care as promising for home care providers that are curious about value-based arrangements.

“I see light at the end of the tunnel,” he said. “I do know that CMS, in their broader plan, wants to see value-based in personal care. They have a framework of at least what was deployed with home health and other settings where they know there can be an impact. My assumption is that they’re leaving things loose enough for the best ideas to percolate, really come up to the top.”

Another important factor to consider is that personal care providers, by and large, have become more expansive in their services offerings.

Synergy HomeCare, for example, has launched a specialized care program for individuals living with cancer, and formed a partnership with a major mental health platform.

While Synergy is just a single company, one doesn’t have to search hard for more examples of personal care providers that are widening the definition of non-clinical home care.

As home care providers continue to expand their repertoire and highlight their role in the health care continuum, , they will better position the industry for more value-based care opportunities, and I predict this will ultimately lead to the establishment of a clear framework for these types of arrangements.

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