Home-based care referrals are no longer won mainly on relationships.
Health systems and payers are increasingly steering patients to agencies that can prove quality ratings, low hospitalization rates, fast acceptance, broad payer coverage and complex-case capability, industry leaders recently said in a Home Health Care News webinar. Home health and home care providers and both investing in technology to capture these metrics.
In decades past, the main driver of a referral was a positive relationship, something along the lines of “I like them, so I’ll refer them,” said Matt Haglund, senior vice president of business development for Aveanna Healthcare.
Now, those relationships have “dwindled” because of a stronger preference for high ratings, the ability to take multiple insurances and lower hospital readmission rates, Hagland explained.
“A lot has changed, and it’s much more metric-driven,” Haglund said. “Being the solution for a hospital system [is key] because, in many cases, they’re not coming to you and saying, ‘Hey, here’s my traditional Medicare.’ They’re saying, ‘I have these three managed care payers, and nobody else will accept them.’”
Aveanna Healthcare, based in Atlanta, Georgia, provides home health, hospice and private-duty nursing services across 39 states.
Hospital systems use these metric-driven results to rank providers for these referrals, Haglund added. Hospital systems are narrowing their referral networks based on star ratings and readmission metrics, while on the Medicare side, electronic portals rank providers by how quickly they accept referrals and the types they accept.
“Relationships matter on the payer front as well, but that only gets you so far,” Haglund said. “The biggest change that I see that we see is being able to generate a high-quality outcome because that is what is generating the cost savings for these payers and certainly freeing up these beds in the hospitals.”
These metrics aim to drive value-based care, which is a main objective for the Centers for Medicare & Medicaid Services (CMS), Hagland noted.
“CMS has done a great job kind of putting that line in the sand to be able to move forward into more value-based care,” Hagland said. “Essentially, they’ve funded rate increases from one provider to another: Your metrics exceed the benchmark, and we will reward you and pay you more for those services because you’re able to keep those patients out of the hospital.”
Improving metric-based outcomes requires tracking data — but getting that information can be difficult for non-medical home care providers, said Dan Deak, founder and CEO of Home Halo.
Greenwood Village, Colorado-based Home Halo provides in-home care for older adults and veterans across eight states.
“Historically, the non-medical home care space has been absolutely terrible at tracking data. We just didn’t,” Deak said. “But the healthcare landscape is radically changing, and companies have been upping their game and doing more with the data.”
He said that, for the past six months, Home Halo has focused on capturing its own data to propel these insights. The firm even invested in custom-made tools to help analyze its information, Deak explained.
Meanwhile, Aveanna uses Trella Health, a healthcare intelligence platform, to bolster business opportunities within its locations, Hagland said.
However, technology is just the first step in helping home-based care providers compete for narrowing referrals. Companies need to effectively interpret their data to secure their spot, Deak noted.
“The data needs to be able to tell a story,” Deak said. “If you just have data just sitting there, it’s just numbers, it doesn’t do you any good.”