What else should be considered besides insurance when referring clients?
Insurance contracts have long been barriers for health care referral sources, many believing home health providers aren’t contracted with enough options to serve their clients’ needs. Making matters more challenging, nearly a year after a change in federal law forced hundreds and thousands of Minnesota seniors to drop their Medicare Cost plans, home health providers are still working hard to reach consumers in need of skilled services by gaining acceptance within insurance companies to provide care.
“In Minnesota for the most part, insurance companies have been closed to new home health providers,” explained Shannon Podewils, RN, Administrator for Lifesprk Home Health. “Meaning they have enough home health providers contracted with them already to meet their members’ home health needs.”
As clients’ insurance plans changed, Lifesprk has had to reach deep within our community and partner relations to be accepted by additional insurance companies. As of August 26, 2019, Lifesprk has been accepted by Blue Cross Blue Shield (BCBS) Medicare. “Our team has been working hard to expand the depth of accepted insurance coverage options we offer,” said Shannon. “Since BCBS picked up many new members as a result of the change over the past year, being able to be a part of this network is exciting and should make referring from transitional care units (TCUs) and our other partners much easier,” said Shannon.
Insurance Options Alone Shouldn’t Be the Deciding Factor
But aside from being easier, it’s about access to the right care that improves outcomes past the 30 or 60-day time limit. “Getting more accepted insurance is only part of reaching more people who need better choices to help them transition home and recuperate or rehabilitate and thrive longer,” said Shannon.
Since Lifesprk added skilled home health capabilities nearly three years ago, Joel Theisen, CEO, still believes strongly in the importance of continuity of care. “As health care shifts towards value-based care, insurance coverage isn’t the only thing referral sources will need to look at,” said Joel. “It will be about outcomes and who has them.” According to a blog in Home Care Home Base, that regulation may come sooner than home health providers realize. By 2022 the Centers for Medicare and Medicaid Services (CMS) plan to make value-based purchasing (VBP) mandatory for all home-health agencies. VBP will move agencies away from the traditional fee-for-service model to an outcomes-based model that shares the rewards for better care – but also shares the risk.
“Models that still use reactive home care approaches do little to improve outcomes, reduce hospitalizations, lower costs, and spark lives,” added Joel. “We need to be able to demonstrate with proven data how we are helping clients reduce the need for care and support social determinants of health – all of these things matter when it comes to referring clients. As we offer choice, we need to look beyond insurance coverage to those home health and home care providers who can do more than just provide medical care.”
In addition to accepting BCBS, Lifesprk also accepts Humana, Medica, Medicare, Preferred One, and UCare. For more information or to request a free consultation call 952-345-0919.
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