Without Proper Post-Acute Care Relationships, MA Plans Are Leaving Money on The Table

Home Health Care News | By Andrew Donlan

Health plans generally do not have great visibility into their members’ care after an acute health event. Even when they do, many aren’t confident in the post-acute care provider that’s serving their member.

These findings come from a new survey of health plans conducted by the post-acute care technology company WellSky.

Specifically, the survey found that:

• Only 37% of respondents (health plans) manage members in a post-acute setting after discharge from acute care. The majority attempt to manage care internally rather than partnering with vendors or other post-acute networks.
  
  
• Just 33% of respondents reported that “the majority” of their members are discharged to “high-performing” post-acute care facilities.
  
  
• 43% of respondents expressed “moderate confidence” that their members receive the appropriate level of care post-discharge.

The health plan respondents – which were Medicare Advantage (MA) plans – ranged from those with 115,000 members to those with over seven million members.

“These findings reinforce what we continue to hear from payers regarding how important it is for MA plans to have greater visibility and proactive influence into their members’ discharges to ensure they are being sent to not only the right level of care, but to high-performing post-acute providers for a member’s specific conditions,” Andy Eilert, president of payer and emerging markets at WellSky, said in a statement. “This will help plans achieve lower total cost, enhanced quality of care and improved member outcomes.”

This is noteworthy information for home health providers, who are trying to negotiate on higher ground with MA plans. Quality home health care can reduce the Medical Loss Ratio for health plans. If those plans don’t have much visibility into where their members are getting post-acute care – in other words, lacking solid partnerships – or are having members use subpar providers, that leaves room for opportunity.

Home health providers that can establish relationships with MA plans, where they can take a certain number of patients in a given market, can negotiate for better rates or a better payment setup than they currently have.

That, in turn, can help bridge the gap between MA’s rates for home health services and traditional Medicare’s rates…

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Neuroscientists Discover Brain Circuitry of Placebo Effect for Pain Relief

Neuroscience | By University of North Carolina Health Care

The placebo effect is very real. This we've known for decades, as seen in real-life observations and the best double-blinded randomized clinical trials researchers have devised for many diseases and conditions, especially pain. And yet, how and why the placebo effect occurs has remained a mystery. Now, neuroscientists have discovered a key piece of the placebo effect puzzle.

Publishing in Nature, researchers at the University of North Carolina School of Medicine—with colleagues from Stanford, the Howard Hughes Medical Institute, and the Allen Institute for Brain Science—discovered a pain control pathway that links the cingulate cortex in the front of the brain, through the pons region of the brainstem, to cerebellum in the back of the brain.

The researchers, led by Greg Scherrer, PharmD, Ph.D., associate professor in the UNC Department of Cell Biology and Physiology, the UNC Neuroscience Center, and the UNC Department of Pharmacology, then showed that certain neurons and synapses along this pathway are highly activated when mice expect pain relief and experience pain relief, even when there is no medication involved.

"That neurons in our cerebral cortex communicate with the pons and cerebellum to adjust pain thresholds based on our expectations is both completely unexpected, given our previous understanding of the pain circuitry, and incredibly exciting," said Scherrer. "Our results do open the possibility of activating this pathway through other therapeutic means, such as drugs or neurostimulation methods to treat pain."

Scherrer and colleagues said research provides a new framework for investigating the brain pathways underlying other mind-body interactions and placebo effects beyond the ones involved in pain…

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Unfulfilled MA Referrals for Home Healthcare Can Lead to ‘Grave Consequences,’ Study Finds

McKnight’s Home Care | By Adam Healy
 
Medicare Advantage patients who are referred to but never receive home health services experience higher mortality rates and lower readmissions compared to those who received such services, according to a new study published in the American Journal of Managed Care.
 
The researchers examined 2,876 acute hospital discharges occurring between January 2021 and October 2022 that included home health referrals. Of these, 2,115 referrals led to the patients receiving home healthcare. The remaining 761 referrals did not lead to home health visits. On average, those who received the recommended home healthcare experienced better outcomes compared to those who did not.
 
“Those members who receive home health services may benefit from additional attention and assistance from healthcare workers, who may in turn advocate for members and escalate situations that could be life-threatening,” the researchers wrote. “Members who are referred to home health but who do not receive services do not receive the same attention and care as their counterparts, and this could have grave consequences.”
 
Unfulfilled home health referrals were associated with lower chances of survival among MA patients at 30, 90 and 180 days. Patients who received home health care had an average mortality rate of 2% at 30 days. That compares to 3% among those whose home health referral was not fulfilled. At 180 days, home health patients had a 11% mortality rate, compared to 14% in the other cohort.
 
However, patients receiving home health care also experienced higher per-member per-month care costs, at an average of $787. Additionally, members who received home health had higher readmission rates, on average, compared to those who did not.
 
Unfulfilled home health referrals can occur for a variety of reasons, according to the researchers. One common reason is that members who do not understand home care services, or who might be uncomfortable with letting clinicians into their homes, may refuse home health. For these patients, the researchers recommended better education, including discussions during hospital stays about what to expect from home health providers after acute care discharge.
 
Also, some home health providers may have trouble contacting or locating referred clients, the study noted, which can lead to unfulfilled referrals. In this situation, case managers can play an important role in connecting home health providers with their referred patients, according to the researchers.

Trella Health Unveils its 2024 Post-Acute Care Industry Trend Report

PR Newswire | Trella Health
 
"As part of our mission to promote industry-wide performance visibility, our team is excited to share the findings of this year's Post-Acute Care Industry Trend Report," said Scott Tapp, CEO of Trella Health. "At Trella Health, we believe in the power of data to foster meaningful change in healthcare. Continuous innovation in an industry requires strong collaboration, and with data-backed insights, we are shaping the future of healthcare together."
 
Below are a few key takeaways from this year's report:

• Medicare Advantage enrollment continues to increase, and MA penetration eclipsed the much-anticipated 50% mark in 2023, hitting 54.7% as of February 2024.
• FFS inpatient discharge instruction rates for home health and skilled nursing continue to inch closer to pre-pandemic levels, though these rates remained more stable than previous year-over-year changes.
• Annualized changes in home health (-3.0% between 2022 Q3 and 2023 Q3 reporting periods) and skilled nursing (-13.8% between 2022 Q4 and 2023 Q4 reporting periods) FFS admissions continue to decrease due to increased MA enrollment.
• Hospice admissions increased by 2.1% between the 2022 Q4 and 2023 Q4 reporting periods. Further, hospice utilization increased to 49.8% in the 2023 Q4 reporting period, four percentage points higher than the 2020 Q4 reporting period. This was due to lower utilization rates during the pandemic when COVID-related deaths were usually not admitted into hospice.

Trella Health invites you to leverage the insights in this report to drive innovation, elevate your business, and build a stronger future for the entire industry.
 
Read the full press-release here or access the Post-Acute Care Industry Trends Report here.