April 13, 2022
Q. How can I leverage my new expertise with outcomes-based models for payer contracts?
A. It’s about continuing to manage goals and broadening outcomes. Payers have members, not patients. That means your perspective in the home has to expand beyond the disease (like COPD) to factors that influence overall health. Are there other factors, such as poorly managed or undiagnosed co-morbidities, that need to be raised to a physician? Are there social factors, such as lack of transportation, utilities, food and safety, affecting the plan of care that need to be forwarded to the payer’s care management team?
Yes, you're the respiratory expert in the home, but if you “own” the home, then you can be the “eyes and ears” to address these broader outcomes.
New models are starting to emerge for respiratory providers who have used outcomes to create respiratory services contracts with health plans. This shift in perspective means you’re getting paid for respiratory outcomes and not just the equipment. Initial respiratory contracts were simple fee-for-service (FFS) agreements that paid for a task like spirometry. However, simple tasks did not encourage “ownership of the patient” nor long-term engagement to lower utilization.
Simply put, no matter how you use and manage it, if you don’t move to an outcomes-based model, you will get left behind. The days of everyone having equal opportunity on a list of post-acute providers will soon be over. CMS has already started the process to change Stark laws and other regulations to loosen the requirements on post-acute providers. The common theme is based on value. If you, as a post-acute provider, can prove you bring more value to the patient by improving quality and reducing hospitalizations, you could become the preferred or even exclusive provider. Link to HME News article