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Telethink a TeleHealth Care Convener

Establishing Affordability and Accessibility for Employers, Providers and Families

We're Your Bridge Between Payer and Provider - Home Health Value Based for Providers

 Our board certified physicians and therapists are on call 24/7/365 and available at very reasonable rates based on census. Licensed in all fifty states and Puerto Rico.

Strategic Partnerships with Home - Based Companies in Value Based Care - BPCI

 A convener is an individual or group responsible for bringing people together to address an issue, problem, or opportunity and monetize it whenever possible.

 

At Telethink Health we simply “activate” the home as a key site in the care continuum through our provider network, which is made up of board certified physicians, behavioral therapists, care navigators, specialists and Rx services. Both physicians and therapists are available anytime, anywhere in the U.S. and Puerto Rico. Our providers are also multilingual.

We are a healthcare convener network, seeking strategic partnerships with home-based care companies to create a more comprehensive and cost-effective enterprise. We provide the necessary services, you reap the benefits.

Telethink Health is uniquely well-positioned to accommodate home-based care providers of any size or population. Monthly subscriptions are based on census. For more information, please contact: Rob Gillespie at telethink@protonmail.com

Currently, approximately thirty-three percent of the population that is 65 and older in the United States (over 25 million people) register for Medicare Advantage.  According to the Centers for Medicare and Medicaid Services (CMS), Medicare Advantage plans will see growth in population and geographic expansion.

According to CMS, the average number of Medicare Advantage plans per county will increase from about 39 plans in 2020 to 47 in 2021.  There will also be an 18 percent increase in plans available in rural counties.  CMS expects 42 percent of all Medicare beneficiaries to choose Medicare Advantage plans for 2021.

“Those that aren’t moving into the new age of how to deliver care from the home health perspective are really falling behind,” Horner said. “Ultimately, they’re not going to see the referral and the revenue stream that’s associated with this marketplace come to fruition for them.” Home Health Care News Feb. 22, 2021

Using the services of a telehealth care convener, will no doubt, be the most cost-effective way to qualify for payer plans and gain referrals by being the best possible partner of choice.

Note: "On October 31, CMS posted the HH PPS final rule, which will allow home health agencies to include the costs of remote patient monitoring, via telehealth, as an allowable administrative cost (e.g., operating expense) on their cost report if the remote monitoring is used to assist in the care planning process." 

 

What Medicare Advantage Plans Want From Home-Based Care Providers

By Andrew Donlan April 14, 2021  Home Health Care News

Medicare Advantage (MA) has provided tailwinds for home-based care providers, as the overall MA member population has grown substantially over the last decade.

In 2020, there were over 24 million MA members in the U.S., over double the amount there were in 2010 and nearly five times the amount in 2005, according to Centers for Medicare & Medicaid Services (CMS) data.

MA opportunities don’t grow on trees, however. Home-based care agencies are undoubtedly worthy in the continuum of care, but each provider has to prove its value to health plans looking to reduce costs and provide better care for their members.

And from the health plan perspective, there is more than one thing they’re looking for, Greg Sheff, the SVP and CMO of Home Solutions for Humana (NYSE: HUM), said on a recent webinar hosted by the Advisory Board.

“One thing is coming with outcomes data,” Sheff said. “From the payer’s perspective, we’re going to look at that and be cynical about it. [We’ll] want to test it and validate it with our own pilots with [the provider]. But talking about outcomes — and not just kind of the pitch on the model — is super important.”

The Louisville, Kentucky-based Humana is one of the largest MA plans in the country. It has also become one of the largest providers of in-home care, namely through its acquisition of Kindred at Home. Its at-home businesses also includes partnerships with the hospital-at-home provider DispatchHealth and the at-home primary care provider Heal.

In addition to Humana, other large MA plans include UnitedHealthcare (NYSE: UNH) and Blue Cross Blue Shield and its affiliates. In total, 3,550 Medicare Advantage plans are available nationwide for individual enrollment in 2021, a 13% increase from 2020, according to the Kaiser Family Foundation.

Data procurement — though one of Sheff’s main recommendations — has not been a strong suit for home care agencies historically. Many providers either don’t have the bandwidth to invest in that type of data collection, or they haven’t found it to be useful in taking care of their patients.

Overall, 75% of home care agencies did not track readmission rates at all in 2019, according to data from Idaho-based market research and education firm Home Care Pulse. Of the 25% that did, it was often rudimentary data tracking.

Still, Sheff believes that data is only one leg of the race to getting payers’ attention.

“The other thing [that’s important] is a little bit more conceptual,” he said. “It’s having specific interventions with specific protocols, specific training, pathways and leading indicators that show us that the thesis of what you … do is going to move the dial.”

An example: If a home-based chronic kidney disease management company was pitching Humana, and part of its thesis was engaging patients with a nephrologist early on.

“We need to see that your members are actually seeing the nephrologist before we start worrying about the dialysis or what the readmission rates are,” Sheff said. “So again, thinking up those leading indicators and making sure you’ve mapped them out.”

It’s also important that home care organizations explain how they’re different from their peers. A generic plan of care team in the home could potentially cut it for some payers, but at least from Humana’s perspective, it won’t.

Come with questions

Providers could bring all kinds of wonderful solutions to the table when meeting with a payer, but they still may gain no headway. To avoid that, in-home care organizations should start by analyzing payers’ pain points.

That’s according to Michael Johnson, the president of the home health and hospice practices at Bayada Home Health Care.

“Come trying to figure out what the pain point is and what the problems are for the payer,” Johnson said. “Because we may be all excited about our outcomes in a certain geography, but only 10% of the people in that population are members of that MA plan [we’re talking to]. So for us, it’s about how we gear it toward a meeting that’s meaningful for the payer.”

Moorestown, New Jersey-based Bayada is one of the largest home health providers in the country. As part of the nonprofit’s network, it has more than 360 offices in 23 states, with additional locations in Germany, India, Ireland, New Zealand and South Korea.

The process sounds simplistic, but in the end, a provider could have all the capabilities a payer needs and still not form a partnership because it failed to recognize that MA plan’s needs at the time.

“In the end, the ability to be successful is going to require two-way communication,” Johnson said. “Because if there’s a problem, we want to come back to our payer partner with [a solution]. It comes down to understanding each other, and quite simply having a relationship where when the chips are down, you’re going to sort of say, ‘We’re going to figure this out.’”

In an ideal payer-provider relationship, both will reap the benefits financially.

That’s the point of procuring the data and forming the best thesis and pitch to an MA plan, after all. But in the meeting, it’s best if the conversation does not start with the provider seeking out financial incentives from the payer, Johnson said.

“Whatever solution you bring, make sure it’s budget neutral,” he said. “Start there and demonstrate that you can make a difference in outcomes that aren’t going to have a negative financial impact on the payer before you start asking for shared savings and so forth. Put your money where your mouth is, [essentially]. I found that’s a much better way to open the door versus, ‘Hey, how much are you going to pay us when we get your readmission rate down?’”

Bayada has had plenty of success contracting with health plans on its end. In March 2019, for example, it announced a major value-based agreement with AmeriHealth Caritas.

There are more MA members and more MA plans than ever, and that offers a great chance for home health and home care providers to open their services up to a larger population as home-based care becomes more popular.

But having a plan — beyond explaining the positives of caring for people at home — is paramount.

Bringing It All Together

1) Medicare Advantage (MA) has provided tailwinds for home-based care providers, as the overall MA member population has grown substantially over the last decade. In 2020, there were over 24 million MA members in the U.S., over double the amount there were in 2010 and nearly five times the amount in 2005, according to Centers for Medicare & Medicaid Services (CMS) data. Because the overwhelming majority of seniors will have Medicare coverage, home - based companies will definitely want them as part of their payer mix.

2) Home-based care agencies are undoubtedly worthy in the continuum of care, but each provider has to prove its value to health plans looking to reduce costs and provide better care for their members.

a) Outcomes data have become an important decision - making factor for payers and

b) "the criteria" for provider referrals (hospitals, clinics, employers).

3) Many providers either don’t have the bandwidth to invest in that type of data collection (because they haven’t found it to be useful in taking care of their patients) or, the health care professionals to create it.

What is a Convener? A convener is an individual or group responsible for bringing people together to address an issue, problem, or opportunity. At Telethink Health, we simply “activate” the home as a key site in the care continuum through our professional network, which is made up of board certified physicians, behavioral therapists, care navigators, specialists, Rx services and an IT division to back it all up. We help home-based providers become the best possible, cost-effective partner of choice.

August 8, 2021 Update: ​"Choose Home Bill Looks to Make Home Health the Center of the Health Care World"  ​https://homehealthcarenews.com...​​Value/outcome based care is here to stay, are you prepared? We provide the necessary services, you reap the profits. https://telethink.net​  #convener #wholesaler #strategicpartner

For more information contact Rob Gillespie: admin@telethink.net anytime.

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