Private Payers News

Highmark Health Plan Brings Inpatient Quality to MA Home Health

The health plan seeks to raise Medicare Advantage home health quality to equal inpatient quality levels with telemedicine and technology-enabled care teams.

Medicare Advantage, home health, CMS, remote patient monitoring, inpatient quality of care

Source: Getty Images

By Kelsey Waddill

- Highmark Health Plan and Contessa are collaborating to raise post-discharge home health to inpatient quality of care levels for Medicare Advantage members.

"Creating a value-based experience that enables patients and families to heal in the home is a priority for Highmark Health," said Monique Reese, DNP, senior vice president, Home and Community Care for Highmark Health.

"Through the Home Recovery Care Model, Allegheny Health Network will provide high-quality in-home services such as home care, home infusion, and durable medical equipment. We are excited to expand our home-focused solutions by partnering with Contessa to provide high-quality acute-level care in the comfort of the patient's home."

The health plan’s Medicare Advantage members and all members in western and central Pennsylvania will enjoy access to telemedicine and technology-enabled in-home providers and care management professionals.

The model targets members who were recently discharged from the hospital and face at-home recovery. Through a combination of digital solutions and care coordinators, the health plan will observe members for thirty days post-discharge to better ensure positive outcomes.

"This new collaboration with Contessa enables us to deliver on Highmark Health's mission to create a remarkable customer experience," said Tony Farah, MD, executive vice president and chief medical and clinical transformation officer of Highmark Health. "We are laser focused on achieving the quadruple aim — to transform health care through proactively improving clinical outcomes and driving better patient and clinician experiences, thereby lowering total cost of care."

The home healthcare industry has experienced some major changes this month in advance of Highmark’s decision to expand its services.

Highmark Health Plan seems to be following CMS’ lead in its home health expansion. The agency finalized a home health prospective payment system rule earlier this month.

The announcement came exactly one year to the day that CMS finalized the 2018 changes—which constitute the current system—which incorporated a case mix payment model.

At the time in 2018, CMS Administrator Seema Verma termed it an “overhaul” of the Medicare home health payment system. While its successor, finalized November 1, 2019, is nothing more than a routine upgrade of the 2018 finalized rule on the surface, the effects of this year’s alterations are far-reaching.

The new rule allows a slightly broader variety of healthcare professionals to perform home infusion therapies, enabling payers like Highmark to offer in-home services to more members. Specifically, this expansion includes therapist assistants, whom previous rules barred from performing home infusion therapies. By allowing therapist assistants to administer these medications at home, the rule combats in-home staff shortage and lowers healthcare spending at the same time.

Highmark chose to extend its home health program by implementing new technologies.  While they have not publicly disclosed the specifics on these technologies, the new tools likely will enable providers to engage in remote patient monitoring (RPM) over the 30-day monitoring period.

Providers have seen significant success in using telemedicine as a tool to monitor discharged patients in recent months and some are using the technology to forge new partnerships with payers.

Henry Ford Health System saw its hospital readmissions drop by 45 percent during the first six months of 2019 as a result of their e-Home Care service. The service provides a tablet and Bluetooth technologies to collect and send biometric information to their care management team. The program also allowed patients to communicate with their providers by phone or virtually.

The hospital is now looking for private payers to cover the tool, for which Medicare provides no coverage and Medicaid’s coverage differs state by state.

Private payers may find opportunities as providers seek partnerships that will cover these services, since public payer coverage is unpredictable.

Highmark will offer its hospital quality in-home model to central and western Pennsylvania and all Medicare Advantage members starting January 1, 2020. The health plan is considering expanding the model to West Virginia and Delaware.