Health plan executives rarely discuss home care models: Survey

A new survey shows that almost two-thirds of executives rarely meet to discuss home care and only 38% say their organization performs “very well” when it comes to supporting members in using home care services.

Poor communication and coordination among various stakeholders, delayed services, and lower member satisfaction are just some of the challenges facing health plans’ implementation of home care.

The survey, released by Integrated Home Care Services (IHCS) and Sage Growth Partners, included responses from 47 health plan leaders. Some of the findings left IHCS leaders puzzled.

“Some 72% of respondents say strategic drivers are the main reason they are starting care to move into the home, but two-thirds say they rarely meet and discuss these cares,” said Paul Pinault, chief development and analytics officer at IHCS, for Home Health News. “These two are almost diametrically opposed to each other. There’s a break there that really left us scratching our heads.”

Source: IHCS

Integrated Home Care Services provides home care to more than 2.2 million patients through partnerships with health plans and risk-bearing provider organizations.

The company is an independent home care benefits administrator that offers a value-based home care model to managed care organizations.

While Pino is encouraged that health plan executives are recognizing the growing demand for home care, there is still much to do when it comes to devoting time and resources to home care.

Over the past five years, 91% of health plan executives in the survey said the use of home care services has increased.

However, the majority (60%) said they supported members’ use of home care “fairly well”.

If those executives know there is a demand, it will be a more appropriate conversation, Pino continued. About the same number of executives, nearly two-thirds, said they rarely talk about home care.

“You would predict that if they rarely meet to talk about it, they probably don’t have an opinion when it comes to home care,” Pinault said. “But they know it’s a problem, it just hasn’t been a focus.”

Pino believes the COVID-19 pandemic has something to do with it. Health plan executives have been so focused and engaged in some of the institutional components of care that home care has not been a priority, he said.

Health plan executives also acknowledged that home care costs have increased: 96 percent of respondents indicated that home care costs have increased in the past five years. Of those, over 25% said spending had increased by more than 10%.

This trend may continue for the next few years.

“There’s an understanding in health care right now that you can only squeeze out so much,” Pinault said. “You won’t get a significant profit from over-squeezing the lowest-cost provider. If you look at any utilization-driven trend and you start looking at the total cost per patient, and when you compare home care to a SNF, the SNF typically has a 200 percent reimbursement rate, on average, per patient, than home care would.”

Home health and home care should see slight jumps in spending, Pino said, especially when it comes to managed care.

Home care strategy and optimization continue to be obstacles for these executives as well. Of the 47 executives surveyed, only 36% said they were “very experienced” in assessing the impact of home care on overall costs.

These results, while surprising in some ways, also held true for companies like IHCS, which can help bridge the gap between health plans and home care.

“The trends that we’re seeing, not only from a utilization perspective, but from a cost perspective, continue to rise,” Josh Holmes, senior vice president of business development at IHCS, told HHCN. “The opportunity for a home care benefit and administrator to collaborate with these populations on behalf of a health plan couldn’t be better.”

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