Economic downturns can prompt states to restrict home- and community-based services (HCBS), but could prompt states to pursue value-based contracts with providers.
State Medicaid programs could consider these value-based arrangements over exclusive cuts or benefit reductions, said industry leaders speaking at Home Health Care News’ PAYER Summit in June.
“Everyone right now should be a little concerned. The sky is not falling, but it’s definitely a lot cloudier than it’s been in a long time,” Allison Rizer, chief growth and innovation officer at ATI Advisory, said on the panel.
ATI Advisory is a healthcare research and advisory firm based in Washington, DC.
Those who are dually eligible for Medicare and Medicaid are typically among the most vulnerable within our populations, said Scott Leitz, vice president in the Health Care Programs department at the University of Chicago’s National Opinion Research Center (NORC).
While individuals dually eligible for Medicare and Medicaid typically have greater needs, economic downturns can end up reducing access to some of the services they require, Rizer added.
“Historically this is what we’ve seen when the economy has a downturn, every state has pulled back on home and community-based services,” Rizer said.
Downturns cause states to squeeze health plans and push new requirements on them, which then impacts how providers offer care, Rizer explained.
“I wouldn’t necessarily expect to see ongoing heavy rate cuts into the future,” Leitz said. “What I would likely expect to see is a greater degree of emphasis on this value proposition.”
That shift could mean providers showcasing how HCBS helps keep clients at home through value-based care. Richard Keller, CEO of PurposeCare, says that is already central to the company’s operating model.
PurposeCare is a Chicago-based company providing home health and personal care services across Indiana, Illinois, Ohio and Michigan.
“From a strategy perspective, what we do is already value-based care,” Keller said. “Our entire business model is based on what the client wants — and, quite frankly, what the payer wants, which is to keep [patients] at home. For us, that also happens to just be good business.”