Home-Based Care Operators Turn MA Contracts Into Lasting Partnerships
Executives say keeping a place in a Medicare Advantage payer network requires ongoing communication, full episode-of-care management, and bringing your own performance data to the table.
Key Facts
- Affected providers
- Home Health
Maintaining a place in a Medicare Advantage payer's network requires far more than signing an agreement, according to executives speaking at Home Health Care News' PAYER Summit.
Chris Cycak-Dyos, director of strategic network operations at Helion, said the No. 1 provider failure is a lack of post-contract communication, and recommended providers shift from visit-by-visit care management to full episode-of-care management and bring their own performance data to payer conversations rather than relying on claims data that can be six months behind.
Cycak-Dyos also urged providers to include clinical teams in contract discussions so leadership understands contract requirements and addresses issues proactively rather than learning of them through denials.
Matt Lippitt, vice president and division director at Bayada Home Health Care, said data creation, collection, and analysis are crucial in home-based care and that data sharing is the foundation of payer relationships, with payers seeking providers that demonstrate quality improvement, dependable access, and reliability.
Justin Meara, senior vice president of managed care at Ignite Medical Resorts, described a case where the company established weekly meetings with senior payer leaders to resolve friction at a Texas facility, underscoring the value of regular, senior-led communication with Medicare Advantage plans.
Sources & References
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