As the registration of Medicare Advantage (MA) continues to increase, home health suppliers have seen that thin margins deteriorate even more. Some suppliers have openly expressed their decision to reject financial financial contracts.
Sometimes it may be necessary to abandon unfavorable MA contracts, industry executives told Home Health Care News. However, some suppliers have improved their MA position through renegotive rates or return after moving away, liver dates and understanding the needs of paying partners.
“We have moved away, in specific states, from the payers and rates of Medicare Advantage Groupse and the inability to increase rates and terms of prior authorization,” G. Scott Herman, CEO of New Day Day Healthcare, told HHCN.
New Day Healthcare, based in Fairview, Texas, has about 33 locations in Texas, Kansas, Illinois and Missouri. The company offers home care services, which include home medical care, personal care services and hospice. It serves almost 150,000 patients annually.
The registration of MA has seen continuous growth in the last two decades. From 2024, 32.8 million people are registered in a MA plan, which represses 54% of the eligible population of Medicare, according to KFF data.
In New Day Healthcare, just north or 60% of the company’s home in the company’s home consists of patients enrolled in MA. The company has a combination of agreements of the entire company and specific agreements of the State.
When you get away
New Day Healthcare is not the only company that has made the decision to move away from an unfavorable payer agreement.
The CEO of LTM Group, David Kerns, views that end the unfavorable relationships for MA as concentrating, instead of moving away.
“You don’t have to be all for everyone,” he told HHCN. “Many times, if you focus on everything, it is difficult to concentrate on anything. Many suppliers think, well, I have in a contract with everyone and do everything. That is not necessarily true. Theme.”
Based in Dayton, Ohio, the LTM Group includes several health, personal care, hospice and rehabilitation companies with more than 500 employees in Indiana, Ohio and Michigan.
MA represents 40% of the LTM group business. Similar to New Day Healthcare, the company has a combination of national and regional contracts.
Renegotiate and return to the table
For Frontpoint Health, ma relations have been the focal point of the company’s business.
CEO Brent Korte said MA represented the rapid majority of Frontpoint Health business, exceeding the typical MA concentration observed between similar size suppliers.
The company’s approach has equipped Frontpoint Health with specialized experience, Short said. Ensure that the Plan recognizes the value provided by Frontpoint’s health.
“If we ask for an increase in the rate,” he told HHCN. “In general, Medicare Advantage plans have economists who are reducing numbers and making sure that any investment in home medical care generates less costs in other places. We are meticulous when illustrating finances and the economy of why, and how our care decreases costs.”
Backed by Cimarron Healthcare Capital and Tacoma Holdings, Frontpoint Health is a health provider and hospice at Dallas headquarters that provides attention in 176 counties in Texas.
Enhaabit Inc. (NYSE: EHAB) has taken the holders to put an end to larger contracts that were unfavorable for the company, namely, the termination of its contract with the UnitedHealth (NYSE: UNH) United groups United in August.
The company any health agreement at home with the insurer.
One of the greatest conclusions of the CEO Barb Jacobsmeyer of the new negotiation of contracts with Medicare Advantage plans is the importance of the data.
“Suppliers must have their data to present,” he told HHCN in an email. “Includes Things Like Timely Initiation of Care, Hospitalization Rates and Readmission Rates – Focusing on The Metrics That Have The Greatest Impact To The Payer. If We Are Are Negotiating With A Payer for The First Time, and Heimsare and Heimare and Hemicaraare and Hemicaraare and Hemicaraare and Hemicaraare and Hemicara. and hemimare and hemimare and hemimare and hemimare and hemimare and hemimare and holysaraare and hemimare and hemimararae and hedicaraararaararaararaararaararaaraaraeaeaeaeaera and Medicare and bring and bring
Enhabit, based in Dallas, has 256 health locations at home and 112 hospice locations in 34 states.
Jacobsmeyer also emphasized the importance of discovering the particular painful points of each plan.
“Define your role in that solution,” he said. “If we are in a renegociating table with a payer, we provide data on the volume of its members that we have cared for and encourage the payer to show us how our results are compared to its Eather suppliers. A supplier partner.”
Similarly, New Day Healthcare has also seen success focusing on the needs of ma plans. Specifically, Herman discovered that Ma plans are looking for home care partners who can ensure that beneficiaries receive care in a timely manner.
“When we meet those terms and win that volume, we can return to those payers and say:” Listen, we have created thesis results, “he said.” We have created this amount of volume. We are taking care of this many beneficiaries, and we need to work with us in a reasonable way now. ”
When negotiating, re -entry rates of the hospital have been a key data point for Frontpoint Health.
“Comparing our re -entry rate of the hospital with the national average and essentially expressing the savings that the insurance plan is based on many hospital admissions that we avoid, that is one of the most prominent ways to do so,” Korte said.
Short pointed out that the readmission rates of the hospital are important for ma plans is that this is typically one of its greatest expenses.
“[MA plans] They are essential cost control organizations, “he said. One of the largest order lines in that expenses model are hospital re -enters and hospital stays. In general, these hospital admissions occur when patients are greater and have multiple chronic diseases and comorbid conditions, which is exactly when home health enters.”
Ultimately, Kerns believes that leaders must make sure to return to ma laser -centered plans and know the true cost of their organization.
“If you enter a negotiation and are trying to negotiate for a certain rate, but in reality it is losing 30 or 40%, you may think you have won, but you really cannot provide good attention, and it is a saturant nucleus.” “Before you come to the table, know where you need to be and continue with that.”
