Home health care providers have recently lashed out at Medicare Advantage (MA) plans for what they believe to be unfair rates for their services. However, there is one new goal, especially in the last year – and that is conveners.
Broadly speaking, conveners are the intermediaries between home care providers and MA plans. At best, they make it easier for providers to do business with these plans and make it easier for plans to work with a wider network of those providers.
Worst of all – which is what home nurses have been focusing on lately – is when they skim the top of already low MA rates and also act as a blocker between decision makers on either end of the relationship.
“If they build skills that we don’t have, God bless them,” Paul Kusserow, CEO of Amedisys Inc. (Nasdaq: AMED), said Monday night during the JP Morgan Healthcare Conference. “Right now, I can look after the plan’s patients better than a Convener. That’s the conversation we had. If they don’t change, their day will end.”
Based in Baton Rouge, Louisiana, Amedisys is a provider of home health care, hospice, palliative care and personal care. Through Contessa Health, which is part of its network, the company also has high acute severity home care options. This network includes 21,000 employees and 547 care centers in 36 states.
Kusserow — who reclaimed his CEO role at Amedisys in November — is a veteran of Humana Inc. (NYSE: HUM), which gives him a unique perspective on what convenors can and can’t do.
In particular, he mentioned three operators that he identified as the most important: myNEXUS, naviHealth and CareCentrix.
Of course, these three are owned by some of the biggest healthcare players in the country, all of whom have massive MA plans.
Elevance Health Inc. (NYSE: ELV) owns myNEXUS. UnitedHealth Group (NYSE:UNH) owns naviHealth. Walgreens Boots Alliance (Nasdaq: WBA) owns CareCentrix.
“The conveners are basically very classic delegated risks,” said Kusserow. “And I’m from Humana. So I’m very used to delegated risk. You give these people everything, you give them 85 cents on the dollar. And their job is to manage that.”
Where the conveners started was the distraction from qualified nursing facilities (SNF), Kusserow said. At that, he declared, they were very good.
“They’re good at … making sure people who are in SNF actually go into the home, and they save a lot of post-acute costs that way,” Kusserow said.
But for everything else, especially when it comes to contracts with MA plans for home health services, Kusserow believes MA plans, like conveners, need to “change their game.”
In late October, Amedisys announced that it had inked a case-rate deal with CVS Health’s (NYSE: CVS) Aetna. Then-CEO Chris Gerard told other MA plans to “take note” of this deal.
“Let’s talk about case-rate deals like we did with Aetna, let’s take more risks and get them to keep migrating,” Kusserow said. “I think if they stay in the delegated game, at some point people will stop signing up with them. And it’s going to really affect their ability to access home health care.”
Market reality will win out in the end, he believes. And this market reality is that home health care providers are enforcing the issue of getting a fair price for their services.
“Organizers continue to push very difficult pricing and management of visits where they don’t really have the knowledge to get the best results,” Kusserow said.
Amedisys and Kusserow are not alone when it comes to the topic of conveners. Other providers have expressed similar criticism in the past.
He’s also not the only top home health expert dealing with conveners.
“I think we’ve accomplished a lot more with managed care [because of our JVs with hospitals], and I have really good relationships with executives,” said Keith Myers of LHC Group Inc. (Nasdaq: LHCG) last year. “But I think our biggest problem is the conveners in the middle of it all.”
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