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Can Medicare Advantage Payers, Providers and Technologists Find Common Ground for Value Based Care?

Picture it: you wake up one morning and instead of working for an in-home care provider, you are now employed by a Medicare Advantage payer – and you’re negotiating a value-based care contract with your former agency that day. How would sitting in the chair on the opposite side of the table change your perspective? 

As a passionate advocate for quality patient care, what would you want your new team to know about what the agency brings to the table? And what might you discover is critical to the payer as you work to strike a fair deal for both? 

That scenario might be a fantasy but it’s all too real that payers and providers must find common ground when it comes to recognizing the value of and potential partnership with the other. We at Forcura know that technology that strategically connects stakeholders and allows the right data to be shared with the right people at the right time is table stakes for a value-based care economy to function equitably – and for healthcare to be sustainable.  

Forcura recently hosted a high-stakes webinar where we challenged our panelists to find the common ground that will make value-based care a more equitable economy for post-acute care providers. 

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First, we explored reasons for the rift among the stakeholders. 

In-home care has a PR problem 

Elizabeth Hamlett, Senior Research Associate at KNG Health Consulting, opened with details from a 2021 report that uncovers just how well the industry would benefit from the fantasy above becoming reality. The report determined that not only consumers, but many Medicare Advantage payers, do not understand either the kind of care that home healthcare providers offer or its value. Wanda Coley, Vice President of Strategy with United Healthcare (and a former home health CEO), added primary care physicians, specialists and hospitals to this group, observing how little these professionals understand about people’s options to age-in-place. If only in-home care providers are aware of their significant impact on patient outcomes, costs and quality – is the gap with MA payers something an ongoing, strategic PR campaign could help close? 

Too few tech vendors focus on the care continuum  

As Forcura’s chief strategy officer Annie Erstling explained, there’s a proliferation of vendors who assist with care delivery in the home. There are far fewer who are working to connect post-acute providers to the rest of the continuum with tools that allow them to operate more efficiently internally and with external stakeholders including payers, referring partners and others. Data creates the evidence of value but without the right tech, data can’t be shared with the right people at the right time. 

Payers and providers need a better playbook  

Jared Hanson, VP of Corporate Strategy for CenterWell Home Health (formerly Kindred Home Health) and Wanda both impressed upon our audience that contract negotiations should not live and die on claims data alone, yet for too many, dialogue never extends beyond this one factor. This fixation creates a sense that negotiations are a zero-sum game, with both sides understandably digging in to protect their own interests. 

The Hard Truth 

Read closely and you’ll see that the three factors above are intertwined. Without a technology infrastructure, data isn’t being shared among parties. Without data, there’s a lack of understanding. Without a common understanding, dialogue is stymied – with massive consequences. As Medicare Advantage is projected to cover 50% of all seniors by 2025, the stakes could not be higher. 

Peter Ross, CEO and co-founder of Senior Helpers and 2022 past president, Health Care Association of America Board of Directors, put a fine point on the costs alone: 
“You have over 12 million dual eligibles in this country that have Medicare and Medicaid. An average cost per year is $320,000 per person – a year! 50% of Medicare spend is on 5% of Medicare recipients. So when are we going to sit up and wake up and say, hey, we can do this much better?” 

Where common ground begins 

Every panelist agreed that keeping people out of the hospital and safely in the home is a natural starting point for payer and provider relationships. Wanda stressed how providers can build on these relationships not just at the time of negotiating contracts, but throughout the year to educate payers on whatever innovations and differentiators they possess. Jared advised that providers be open to the benchmarks payers can share on how other providers implement utilization management for better outcomes and lower costs. Peter reminded everyone that professional caregivers are often the first to observe and act upon a change in patient condition – cementing home care’s value and role in being integrated more fully into the value-based care economy. And Annie closed by imploring our audience to rely on forward-thinking technology partners to help providers and payers tell a data-driven story with a language common to all. 

Want to know more about how in-home care providers can earn a seat at the value-based care table? Access our 2022 Forcura CONNECT Summit recordings or this webinar now. 



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