Measuring value and success: How home care agencies can prepare for any Medicaid cuts

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  • October 24, 2017

The latest attempts to pass a comprehensive healthcare bill aren’t the first to include significant cuts in the rate of Medicaid spending. When half of all Medicaid long-term care funding is used to support in-home care services, if these bills pass there could be a significant impact on home care reimbursements. Luckily, the home care industry has been preparing for these cuts for years. By adjusting operations to focus on data and measurement, especially value-based care and increased referrals, agencies will be better equipped to handle whatever changes lie ahead.

Regardless of potential Medicaid cuts, governments and MCOs are shifting to a value-based model, which looks at the quality of care delivered for the price paid. In replacing the traditional fee-for-service models, home care agencies will need to shift their operations to ensure maximum efficiency and value in the days ahead due to increased pressure from MCOs. MCOs are trying to ensure their managed populations remain healthy enough to stay in their homes, and preventing hospital readmissions is the number one goal to drive value in both cost and quality of care.

Home care agencies need to show MCOs they are the provider that can deliver effective care and keep patients out of the hospital. To do so, they need to look at current processes and understand how they can effectively demonstrate key metrics required in the shift toward value-based care.

Manual processes are a significant hurdle to these changes, but can be addressed by leveraging an agency management solution that automates back-office functions. Being well run isn’t enough, as both states and plans are under pressure to develop payment processes that demonstrate value. Agencies who effectively use these solutions will find a significant advantage over their competitors as they optimize processes and painlessly track critical metrics.

Expecting the unexpected is impossible, and there is only so much we can do to predict what will happen in Washington, but home care provider agencies can remain ahead of the game by implementing effective measurement in their day-to-day operations. When focused on value-based care and maximizing referrals, agencies are poised to grow no matter what challenges arise.

See how HHAeXchange’s agency management platform can help your agency reach success, automating and streamlining processes to increase the value of member care.