“You’ve obtained to know when to carry ’em, know when to fold ’em, know when to stroll away.”
Sure, these are lyrics to the enduring Kenny Rogers hit track, however they’re additionally reflective of an thought an increasing number of home-based care suppliers are making use of to their negotiations and relationships with Medicare Benefit (MA) plans.
Jet Well being has first hand expertise with strolling away from a relationship with an enormous MA plan.
“As a regional supplier of residence well being companies, we had to take a look at these margins and the way we finest deploy our nurses and our therapists,” Jet Well being CEO Stacie Bratcher stated Monday throughout a panel dialogue on the Dwelling Care 100 convention in Orlando, Florida. “We have been beneath water with certainly one of our giant suppliers. We needed to resolve, can we keep in-network with some actually poor charges that have been beneath what our per-visit price was, or can we exit?”
The Fort Value, Texas-based Jet Well being is a house well being, hospice and private care supplier that operates in Texas, New Mexico, Colorado and Idaho.
Jet Well being leaders requested the MA plan for a price improve a number of instances and have been denied a number of instances. This prompted the corporate to exit the connection, in keeping with Bratcher.
“In that negotiation course of, they did come again to us and say, ‘Nicely, we actually worth you as a supplier, so we’ll offer you …’ principally sufficient to maintain us on the hook,” she stated. “It was an especially troublesome resolution for us as a result of it was a market that we had been in for a really very long time — referral sources that relied on us, sufferers that relied on us.”
It got here all the way down to changing into a smaller – however extra worthwhile – enterprise versus persevering with to tackle these sufferers on a big scale whereas shedding cash.
Now, for Jet Well being, it’s been necessary to maintain price stability high of thoughts when forming payer relationships.
“Actually taking a look at how comfy we’re with our price stability — is that going to alter sooner or later, as a result of if you tackle these threat contracts, you’re not going to see that upside for a 12 months or extra,” Bratcher stated. “We don’t even acknowledge that income as income, and we defer that till a later time limit.”
Amedisys takes a stance with MA
In October, Amedisys (Nasdaq: AMED) was very public about its stance on not working with payers that fail to notice the corporate’s worth, and then-CEO Chris Gerard even urged MA plans to “take observe” in reference to the corporate’s take care of CVS Well being’s (NYSE: CVS) Aetna.
Earlier this month, returning CEO Paul Kusserow prompt that Amedisys’ take care of Aetna be used as a blueprint, whereas additionally taking purpose at conveners.
“Let’s speak in case-rate offers like we did with Aetna, let’s go extra in danger on issues and get them emigrate additional,” Kusserow stated in the course of the J.P. Morgan Healthcare Convention.
Andrew Galbierz — senior vice chairman of payer relations at Amedisys — additional reiterated this sentiment.
“It’s actually about figuring out the belongings that we’ve, that are our nurses and our folks, and actually being strategic about how we deploy these belongings,” he stated in the course of the Dwelling Care 100 panel dialogue. “Because it pertains to Medicare Benefit, we’re going to deploy these belongings based mostly on the companions which might be prepared to work with us and which might be prepared to compensate us pretty for what we do.”
The Baton Rouge, Louisiana-based Amedisys’ service strains embody residence well being, hospice, palliative and private care. It additionally has home-based, high-acuity care capabilities via Contessa Well being, which is part of its community. That community consists of 21,00 workers and 547 care facilities all through 36 states.
When negotiating contracts with MA plans, it’s necessary for suppliers to grasp the affect that residence well being has on the entire price of care, in keeping with Galbierz.
“As [we] begin these value-based conversations, [we] give it some thought from the attitude of, we provide companies to key sufferers of their residence,” he stated. “That, clearly, retains them out of the services or higher-cost settings. From a strategic standpoint, it’s about working with the plans that perceive that mindset and perceive the worth that we deliver as a house well being company.”
It’s additionally necessary for suppliers to grasp the payer, in keeping with Katy Lanz, principal advisor at TopSight Companions, a Pittsburgh, Pennsylvania-based medical design and innovation agency.
“They’re very totally different, and their wants are very totally different,” she stated in the course of the dialogue. “Some have a number of distributors fixing plenty of points, and a few have a funds that they wish to isolate simply in the direction of sure percentages of their Medicare Benefit inhabitants. It’s important to know who you’re speaking to and perceive what issues they’re dealing with, after which see if it suits inside your functionality stack.”
In the end, Galbierz believes suppliers ought to tackle a “my community versus their community” mentality. In different phrases, what MA plan does the supplier need in its portfolio?
“It’s crucial to have the ability to acknowledge shifting from that commodity into that scarce useful resource, and forming these partnerships which might be going to deliver essentially the most worth,” he stated.
