This post talks about Home Care and Hospice companies and what the ACO (Accountable Care Organization) movement means to their business development efforts. As I sit here watching my Lions play the Packers (tied up 7-7) and write this, I am Skyping with a colleague here in Michigan who operates a Home Care and Hospice company. We are talking about how his strategies differ as he approached several ACO with his Home Care operation and Hospices, and how he is working with several ACOs.

We are three years into the ACO experience. For me, ACOs are HMOs in “drag”. Another attempt by CMS using the Affordable Health Care as a backdrop to control health care spending.

Here is something to think about……based on how the shared reward/bonus for ACOs is calculated, it is feasible that after three years an ACO will, drive, costs low and quality measures high to a point that the outcomes are the best they are going to be. Thus, limiting bonus opportunities. Then what?

I know several ACOs around the country that have as a strategy to build their ACO members and then over time, try and drive their members to other programs they operate such as the Medicare Advantage program. Very slice!!

Here are a few interesting stats from last year that you might find interesting.

• The percentage of hospital discharge to a Post-Acute Care (PAC) settings: 15% to home care and 2.1% to hospice.
• The percentage of re-admissions from a PAC setting: 18.1% home care and 4.5% hospice.

The fellow I am Skyping with (a current client) approached the ACOs he works with and had data that addressed the following elements.

– He approached them with credible data

• Few 30-day hospital readmissions
• High volume of discharges to home

– He had geographic coverage convenient to primary care physicians and hospitals.
– He already have positive relationship with hospitals and PCPs which was a plus.
– He was willing and able to be part of health information exchange

The biggest value his company brought to the ACO was his hospice operation. While he couldn’t participate in the ACO bonus program (Hospice’s cannot be formal partner in ACOs), he was able to assist the ACO by accepting high acuity complex patients. My client would build the case for the ACO that most patients discharged to an LTACH and some to Rehabs could actually be admitted to hospice once they are discharged from a hospital as oppose to other parts of the continuum as they were most likely hospice eligible upon discharge. By making a referral to hospice from the hospital, you avoid the cost of the LTACH, possibility home care as it is most likely these patients will end up in hospice. A very attractive opinion!!

This rationale and approach worked for him as his company participates to care conferences and patient navigation discussions. Bottom line, this approach assisted my client further serve more patients, grow census and strengthen profitability. The big bonus, however, was how his company strengthened relationships with other members of the ACO which led to volume growth.

The lesson learned is be respectfully persistent in approaching your ACO. Second, make sure you have your clinical and financial outcome data ready to share. Lastly, the ability to sit at the table and develop productive relationships is always a good thing.
Wishing you good health!