Payer Diversification Strategies for Home Health Care Agencies

CMS has proposed a cumulative $18 Billing cuts to Home Health reimbursements over the next decade. While Home Health Care Agencies are finally coming out of the woes posed by COVID-19, potential reimbursement cuts, along with the HHVBP model, have created additional challenges for Home Health agencies. These cuts will have a much higher impact on the agencies providing only Medicare Certified Home Health Services.

Home Health Care Agencies can adopt payer diversification strategies to mitigate the impact of reimbursement cuts by diversifying the payer mix and services offered. Diversifying the payer mix will reduce volatility in revenue and mitigate the impact of reimbursement cuts for the agencies.

Diversification of Payers and Services

Home Health Care Agencies looking for diversification and growth can focus on expanding their service offerings and diversifying their revenue sources. Agencies can look to expand the services using the skill sets they already have. Diversifying payer sources will help agencies balance revenue volatility across payers.

The following are some ways agencies providing Home Health Services can expand the services offered and diversify the payers.

Medicaid and Medicaid Waiver Services: Agencies can expand the services to include Home and Community Based Services (HCBS) for Medicaid and Medicaid Waiver programs. Many more policy discussions are going on about increasing the funding for HCBS services instead of funding for Medicare services. COVID-19 assistance has improved states' financial condition, improving the reimbursement environment for Medicaid and Medicaid Waiver services. These services can be provided with the skill sets agencies already possess.

Private Duty Nursing Services: Another potential area agencies can expand to Private Duty Nursing Services for medically fragile pediatric or adult patients. These services are funded by Medicaid, Medicaid Waiver, or Private Insurance companies. Home Health Agencies already have the skill sets to offer these services.

Outpatient Therapy at Home (Part B Therapy): Agencies can also start providing Outpatient Therapy (Medicare Part B) Services at patients' homes. Therapists from the agency are already providing these services at patients' homes. Providing outpatient therapy services can be the natural extension of continuing assistance to a patient after the patient is discharged from home health services.

Hospital at Home and SNF at Home: Private Duty Nursing and Outpatient Therapy at Home will enable home health agencies also to provide Hospital-at-Home or SNF-at-Home services. Home Health Care Agencies can form partnerships with local hospitals and Accountable Care Organizations to offer these services.

Expanding the services and diversification of payers will require agencies to reorient their marketing, train their employees, and find the right technology platform.

Right Technology Platform for Diversification of Payers and Services

The software platform will play a critical role in helping Home Health Care Agencies to expand their service offerings and diversify revenue sources. A software platform that can support all these services under ONE Patient will significantly assist the agencies in their efforts of diversification and growth.

The following are some of the critical features the agencies should look for:

ONE Patient: The software should allow the agencies to maintain ONE Patient record for all the services. One patient for all services will provide a consolidated clinical and financial view for the patient leading to improved quality of care and patient satisfaction.

ONE Employee: The software should allow the agencies to maintain ONE Employee record for all the services. One employee for all services will allow management employees to schedule across all services. This will significantly reduce schedule conflicts and overtime expenses, improving employee satisfaction and the agency's bottom line.

Manage and Bill Payers: The ability to manage and bill disparate payers for all the services and payers will be necessary for agencies looking to diversify their payer mix. The software should be able to bill different payers – Medicare, Medicaid, Private Insurance, and Private Pay – meeting their claim submission requirements.

Consolidated Clinical View: Keeping all the clinical records under ONE Patient records will provide a consolidated clinical view for clinicians and caregivers. This will improve the quality of care, patient satisfaction, and employee satisfaction.

Consolidated Reports: Providing consolidated reports and dashboards will help agencies to manage these services effectively. Using ONE Software with One Patient and Employee record will require less employee training and improve their productivity.