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Home Health Care’s Role in Accountable Care

By Stephen Tweed

The other day I was preparing for our bi-weekly online sales meeting with a home health agency sales team in southern California.  During our last meeting, the sales reps had been asking some questions about having contracts with IPAs (Independent Practice Association).  It turns out that many physicians in the state are members of an IPA, and these IPAs contract with health insurance companies, and for our client to get referrals for home health, they needed to be part of the provider network for the IPA.

In researching this issue, I discovered a lot of information about IPAs and Accountable Care Organizations.  That led us to an interesting conversation about the role of home health agencies in forming ACOs.

There’s good news and bad news about home health and accountable care.

The good news is that the work that we do in the patient’s home can contribute significantly to reducing the overall cost of care for an elderly Medicare beneficiary.

The bad news is, most health system executives and physician group administrators have little or no knowledge of home health care, the positive outcomes of patients receiving home care, and the role we can play in reducing costs.

The other bad news is that our industry has not made significant progress in reducing the percent of patients in home health care who return to the hospital during a 60 day episode of care.  According to CMS, 19.2% of Medicare patients are readmitted to the hospital within 30 days of discharge, and 28.2% are readmitted within 60 days of discharge.  When we look at the Home Health Compare web site, we see that currently 27% of Medicare home health patients are readmitted to the hospital within the 60 day episode.

We’ve got to be able to demonstrate that home health agencies can have a material impact on the quality of care, the cost of care, and the efficient operation of an ACO.

What you can do to be part of Accountable Care?

As we continue to study how home health agencies can be a part of accountable care, here are three strategies to consider:


1.  Learn about ACOs


Before you consider how your agency will participate in accountable care, you need to learn as much as you can about the concept of ACOs, how they are included in the Patient Protection and Accountable Care Act (Health Care Reform), and what types of organizations are authorized to form ACOs.  For some background information, here are a couple of links you may find helpful.

http://en.wikipedia.org/wiki/Accountable_care_organization

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/ACO/

2.  Learn about the ACOs in your service area

While the discussion of ACOs among home health care leaders is wide spread, the number of actual ACOs that are beginning operation is relatively limited.  Here is a list of ACOs.  Check to see if any are in your area.

80 Accountable Care Organizations to Know

You can also learn more about the Pioneer ACO by reading the fact sheets from CMS.

3. Get to know the ACO C-Suite Executives in your local service area

Selling home health services to ACOs will be a C-Suite to C-Suite sales process.  Don’t expect your front line sales reps or even your Director of Marketing to make the sale.  The CEO and executive team of your home health agency will need to develop relationships with the C-Suite members of the ACO. You’ll need to gain their confidence, get the big picture of their approach, and determine how they will contract with other providers.

Then you’ll need to put together a powerful, persuasive sales presentation on how your agency can help them achieve their goals, save money for Medicare, and share in the savings.

Let us know about your Experience with ACOs

If you have an ACO in your local marketplace, and you have made contact with them, we’d like to know about it.  We’re continuing to gather data and anecdotal information about how home health agencies are participating in this innovative process.

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