By Kim Glenn, Senior VP Government Health Plans for HHAeXchange, shortlisted for The SaaS Awards 2022 at the Best Product for Healthcare category

Homecare Demand on The Rise

The pandemic multiplied the demand for homecare, with projections that by 2028, the U.S. home healthcare services market will reach $175 billion. Essential stakeholders including regulators, payers, providers, caregivers, and members now accept homecare as a valuable, cost-effective alternative to facility-based care. These services and their providers are being recognized for the value they bring not only to the members they serve but to the overall healthcare system as well.

Medicaid recently surpassed 80 million beneficiaries — the highest number since the program was created in the 1960s. Simultaneously, America’s elderly Medicare population is growing and further driving demand for homecare services. According to an AARP Public Policy Institute research story by Edem Hado and Brendan Flinn, as of 2021, more than 80 percent of adults expressed a desire to remain in their homes as they age and prefer a home setting over a nursing home or other care facility. This growing momentum for home and community-based services (HCBS) reinforces the need for payers to efficiently manage homecare networks while ensuring quality care.

As the reimbursement models shift from fee-for-service and managed-care models to value-based care, payers must reach beyond compliance and manage their homecare networks with seamless connectivity across stakeholders.

More Than Meeting Compliance

Enacted in 2016, the 21st Century Cures Act sought to increase choice in providers and broaden member access. Meeting Electronic Visit Verification (EVV) requirements under the act is a necessity, and those who offer homecare management software, like HHAeXchange, have been committed to providing solutions to expedite that adherence. An effective homecare network management system can do more than just ensure compliance, though. Payers can evaluate a variety of capabilities for homecare network management to drive connections across the homecare ecosystem, create efficient workflows, and drive high-quality member care. A truly valuable homecare network management system will scale as the homecare populations grow. And, it will flex as compliance requirements evolve.

Payers should consider five elements to improve efficiencies and workflows for a higher quality of member care across every touchpoint, from acquisition through care coordination and ongoing engagement. Together, this functionality encompasses comprehensive homecare network management.

Centralize Payer & Provider Collaboration

A true, centralized hub connects payers and providers across the homecare ecosystem, enabling greater collaboration and access to data that is essential for care planning and informed decision-making.

Additionally, continuity of care requires efficiencies from technical features such as configurable real-time alerts. Such alerts can trigger manual and auto assignments to prevent delays in addressing critical care needs, missed visits, and more, in a timely manner.

Enhance Value-Based Care Initiatives

With seamless connection with providers, payers can easily share a member’s open care needs with their providers. This prompts homecare providers to address care gaps and, when necessary, coordinate care with other providers – all in a timely manner. This reduces time for members to receive needed care and improves their outcomes.

Further, payers can enhance value-based care initiatives by leveraging insights from caregivers during home visits. Caregivers can capture information on social determinants of health such as food insecurity, other risk factors like fall hazards, and changes in condition, for actionable insights into risk factors. 

Effectively Broadcast Cases and Successfully Manage Authorizations

Managing efficiency, compliance, and member care coordination is an end-to-end, continuous endeavor  — which makes configurability the key to effective case broadcasting. Capabilities like one-click auto broadcasting based on person-centered caregiver attributes, service needs and location ensure members receive appropriate, timely care. With expanded visibility, payers can better serve their members during caregiver shortages and prevent multiple providers from responding to a case with real-time placement status updates.

The ability to set configurable authorizations guardrails, together with insightful reporting, can reduce both overutilization and underutilization.

Pay Claims with Confidence

A system to auto-validate EVV compliance and authorization parameters prior to claims payment ensures the appropriate level of care is provided and billed correctly. This allows payers to reduce claim denials and provider abrasion while improving internal processing times.

As homecare membership continues to grow, optimizing operations with configurable functionalities that protect payment integrity will become a key value driver.

Make Informed Decisions with a Comprehensive Intelligence Tool

It takes more than a single dashboard to make better, more informed decisions regarding provider performance and member care. To truly meet the needs of members receiving homecare, payers can invest in a comprehensive, yet flexible, intelligence tool.

A drill-down look at visits allows visibility into member care, including missed, late, short visits, and caregiver compliance. Accessing truly valuable data allows improved decision-making on member care and evaluation of provider performance. Greater oversight helps health plans identify provider trends and network outliers, encouraging plans to utilize the highest-performing providers and address required improvements with lower-performing providers.

The Value of One Connected Ecosystem

Connecting the homecare ecosystem enhances workflow efficiencies and enables greater collaboration, and, ultimately, meets the growing need for quality care in the home resulting in improved member outcomes.