In Rapidly Changing Value-Based Care Landscape, Home-Based Care Providers Facing Crunchtime

Home-based care providers avoiding the shift to value-based care are running out of time and excuses.

The Centers for Medicare & Medicaid Services (CMS) wants 100% of traditional Medicare beneficiaries and the “vast majority of Medicaid beneficiaries” in accountable care relationships by 2030.

Home health providers are already under the Home Health Value-Based Purchasing (HHVBP) Model, which is, by definition, a value-based care model.

Plus, the share of Medicare Advantage (MA) beneficiaries is increasing, while the share of traditional Medicare beneficiaries is declining. MA plans pay less for home-based care services, and value-based arrangements may be the best way for providers to achieve healthy financial relationships with those plans.

Even if providers are not capable of moving fully toward value-based care on their own, there are plenty of partners that can help them get there. They’re not just health plans.

There are value-based payment enablers, risk-bearing delivery organizations and hybrids of the two that can be leveraged by providers.

Healthcare Management Administrators (HMA) recently released a 70-page report on the current value-based care landscape. CMS also recently unveiled a value-based care spotlight webpage to aid providers.

This week’s exclusive, members-only HHCN+ Update pulls from those new resources, as well as recent conversations with home-based care leaders, to paint a picture of what value-based care currently looks like from a home-based care provider perspective.

Value-based care entities

When regulators point toward and acknowledge a trend they’ll be following over the next decade, the private sector generally listens closely.

As value-based care has gone from a pie-in-the-sky term with no real meaning behind it to something legitimate, more opportunities have arisen for providers interested in moving further toward value.

“At the start of the movement, value-based arrangements primarily involved traditional providers and payers engaging in relatively straight-forward and limited contractual arrangements,” HMA’s report read. “In recent years, the industry has expanded organically to include a broader ecosystem of risk-bearing care delivery organizations and provider enablement entities with capabilities and business models aligned with the functions and aims of accountable care.”

It’s worth noting that most home health providers have been making shifts toward value, particularly after the implementation of the Patient-Driven Grouping Model (PDGM), which de-incentivizes volume.

But it’s also worth noting that providers were entrenched in the fee-for-volume cycle for a long time. Whether they would admit it or not, undoing those habits is an ongoing chore.

Luckily, they don’t have to do it all on their own.

HMA identified three different types of entities worth paying attention to in the current value-based care landscape, for instance:

– Value-based payment enablers: “Entities that partner with providers to help them in the transition to value; share responsibility for the cost and quality outcomes; does not own provider asset.”

One example given by HMA here was Caravan Health, which was acquired by Signify Health in 2022. Signify Health is an at-home care solutions enabler owned by CVS Health (NYSE: CVS). It is not a traditional home health provider itself, but does partner with home health providers.

“We talked a lot through this journey about home health,” CVS Health CFO Shawn Guertin said after the Signify acquisition, also in 2022. “And the value-based care capabilities that this brings us is where a lot of the power is, I think, for the long haul. I’m very excited about the opportunity that Caravan could provide us for the future.”

– Risk-bearing delivery organizations: “Entities designed to deliver value-based care from the outset and assume accountability for the cost and quality outcomes of patient populations.”

Oak Street Health, which is now also owned by CVS Health, is one of these risk-bearing delivery organizations. It’s clear what CVS Health is trying to do from a strategic perspective.

Another entity mentioned is CenterWell, the provider organization owned by Humana (NYSE: HUM). CenterWell has three pillars currently: pharmacy, primary care and home health.

Over the next few years, CenterWell President Dr. Sanjay Shetty wants home health care to play an even larger role in the entity’s overall value-based care goals.

“I think the intent, with our pivot into value-based models for the home, is to first prove [things out],” Shetty told me this week. “We are making those investments within the business and within the clinical model, in order to change the way we’re doing things – to orient the teams on the ground towards the outcome. We’re still probably in the early days of that journey, but it’s been exciting.”

– Hybrids: “Entities that own risk-bearing delivery assets and offer VBP enablement services to external providers.”

A prime hybrid, which HHCN has covered extensively, is VillageMD. A primary care provider with a home- and community-based focus, VillageMD is backed by Walgreens Boots Alliance (Nasdaq: WBA). The latter has put up over $6 billion behind the former’s business.

“Home-based care is just going to become even more important,” Dr. Clive Fields, VillageMD’s co-founder and CMO, told Home Health Care News in 2021. “With the use of technology, teams and analytics, we think we can drive the same kinds of results for people who previously just may not have that access, either because of where they lived or because of the transportation that was available to them.”

Where providers stand

Some providers are taking on risk without a partner, through a Program of All-Inclusive Care for the Elderly (PACE), for instance. Some are partnering with PACE programs, too.

Other home-based care providers are partnering with health plans in value-based arrangements, though historically those have been on a more limited basis.

Home-based health care is lower-cost care, and also drives desirable outcomes when delivered correctly. Therefore, the aforementioned three types of value-based entities could all use home-based care providers. At the same time, the providers would also benefit from engaging with organizations already set up to deliver legitimate value- and risk-based care.

The first step is generally a cultural change, which is something I noted in last week’s update as well.

“I think the first relationship that you must establish – and this sounds a little hokey – is a pretty good internal harmony with your employee base, your stakeholders, your board, your governance, structure, whatever that might be,” Chapters Health System Andrew Molosky told me last month. “Because nothing will waylay an organization faster than when you have people viewing the priorities differently.”

CMS’ spotlight on value-based care reaffirms their commitment to the 2030 initiative, but it also proves just how behind many providers still are.

The webpage goes over some of the basics of value-based care – why it matters and how it can be achieved.

“CMS just launched a new Value-Based Care Spotlight page that explains in plain language what we mean by value-based care,” CMS Deputy Administrator and Director Liz Fowler said in a statement. “How it supports patients and providers, and why value-based care is important.”

Even if most home-based care providers are behind, value-based care will have to wait.

Time is of the essence, but health plans, patients and risk-enabled providers need home-based health care to truly provide the value-based care CMS wants.

“As with other healthcare organizations, entities in this segment are expanding their in-home care capabilities to support patients and caregivers in low-cost, convenient settings and a growing cohort of home-based innovators is emerging, each with slightly different approaches to optimizing in-home care,” the HMA report read.