Diversifying payer sources and optimizing payer relationships are crucial strategies for post-acute care agencies to thrive under the value-based purchasing (VBP) model. This approach not only mitigates financial risks but also enhances the quality of care delivery. Let’s explore key strategies and how HealthRev Partners and our technology partner, Forcura, can support home health agencies in this quest.
Diversifying payer sources means that rather than relying on just one or very few primary payers, agencies actively seek revenue from a variety of different sources, like multiple insurance companies, government programs (Medicare, Medicaid), and private pay patients, thereby reducing financial risk and stabilizing cash flow.
Expanding Service Offerings and Payer Diversity
Diversifying service offerings is a strategic way to attract various payer types and reduce dependency on a single revenue source. This approach can include:
- Analyzing current staffing and identifying areas of expertise that can be optimized
- Developing specialized programs for chronic disease management
- Implementing transitional care programs to reduce hospital readmissions
Home health agencies can expand their services to include Home and Community-Based Services (HCBS) for Medicaid and Medicaid Waiver programs. This expansion allows agencies to reach a broader and more diverse patient base, as different payer sources often correspond to different segments of the population.
Cultivating Strong Payer Relationships
Building and maintaining strong relationships with multiple payers is essential. This involves regular communication, collaboration with payer representatives, and demonstrating value through data-driven outcomes. Forcura’s software platform offers agencies a centralized, end-to-end referral management system that simplifies and accelerates every step of the patient intake process, helping to strengthen payer relationships. HealthRev Partners’ Velocity platform drives data collection to demonstrate value and prioritize business needs.
Conducting Regular Payer Assessments
Regular payer assessments are crucial for understanding the financial health and performance of your agency. HealthRev Partners’ expertise in revenue cycle management can assist in:
- Analyzing reimbursement rates across different payers
- Identifying trends in claim denials or delays
- Evaluating the profitability of various service lines
Efficient Management of Payer Requirements
Each payer has unique requirements and processes. Efficient management involves implementing robust systems to track and manage different payer rules and ensuring proper setup and configuration for each payer in your billing system. Forcura’s platform allows agencies to manage referrals, patient information, and insurance details all on one platform. Managers can use Forcura’s Referral Lifecycle Report to easily identify and eliminate bottlenecks in each stage of their process, enhancing productivity and helping agencies meet tight timelines with confidence.
Leveraging Technology for Patient Prioritization
Forcura’s Generative AI-powered IQ technology exemplifies how agencies can use advanced tools to optimize their payer mix. This solution allows agencies to quickly sort new referrals by various referral data points, including payer, apply specific business rules to prioritize patient acceptance and streamline the intake process based on your preferred payer strategy.
Implementing Value-Based Care Strategies
To succeed under the VBP model, agencies should focus on implementing evidence-based care protocols, enhancing care coordination across the continuum, and utilizing data analytics to drive quality improvements. HealthRev Partners emphasizes the importance of leveraging data to improve clinical and financial outcomes in this new paradigm.
By combining Forcura’s front-end efficiency with HealthRev’s precise back-office RCM processes, agencies can achieve a new level of financial predictability. This partnership ensures that agencies can maintain a steady cash flow, enabling them to focus on delivering exceptional patient care without the constant worry of delayed or inconsistent revenue.
In conclusion, diversifying payer sources and optimizing payer relationships are essential strategies for home health agencies to thrive in the current healthcare landscape. By leveraging the combined strengths of Forcura and HealthRev Partners, agencies can streamline operations, reduce errors, and improve financial outcomes, ultimately leading to better patient care and sustainable growth.
