As healthcare continues to evolve, new groups are forming – ACOs. Accountable Care Organizations or ACOs are becoming the newest and hottest trend in healthcare. From hospital systems to physician groups partnering with other providers, the new survival trend is to ensure stability and sustainability in a shrinking world of reimbursement.
In order to survive, providers are choosing partners that synergize with their current services. For most home health providers, this is going to be a huge enhancement to their line of business by becoming the preferred providers of a physician group or large hospital system based ACO. ACOs can come in a variety of configurations. They can include nursing facilities, physicians, home health, hospice, outpatient providers and hospitals.
As home health and hospice faces new scrutiny and potential new regulations, it’s important that your agency becomes aware that operating in a silo can bring about your own demise. Data is running healthcare now. We know this first hand with the data that is easily made public by CMS on Home Health Compare and many other ‘Compare’ sites. Also, we have the ability to analyze quite a bit of data on many providers through the use of raw data extractions of useful information – not necessarily the twisted information that gets mauled by archaic cost reporting methods.
Your data is out there – you use it, your competitors use it, and now your referral sources use it. ACOs want to be with agencies that provide quality care – or at least provide quality care on paper. Therefore, if you have an average rating on Home Health Compare, ACOs are not likely to want your agency to become part of their group.
Flashback to high school with the popular kids, ‘the mean girls’, and the athletes vs. the shy, smart, but slightly awkward kids in the cafeteria. While the shy, smart, awkward kids of the industry are likely providing very good care to their patients, their publicly reported data might not always reflect that. This outcast group of kids at lunch are similar to smaller agencies who have not yet been able to either figure out their niche and fit within the community or to fully form a suitable bond with strong referral sources.
It sounds like a traditional popularity game – and it is. The agencies that have strong marketing staff and focus on developing partnerships with multiple groups of providers outside the traditional model of the local doctors are booming. These agencies understand the importance and reward of investing in their agency. Investment comes not just from technology but in clinical staff and making sure their ‘popularity’ remains strong so they can become the homecoming king and queen.
ACOs want the King and Queen of Homecoming. ACOs want the 4 and 5 star agencies. Where is your agency ranking these days? With the first year anniversary of data publicly being made available in the form of stars, how much has your agency changed? Have you improved your clinical processes, your internal quality benchmarks that are reflected in better outcomes?
We know that sometimes this can be tough with your agency’s patient population. Some patients within your agency can sometimes have much longer term based needs which drive down scores. But that is when business management needs to come into play. Knowing how to turn down a patient might seem unkind, rude or simply that you are in business for the money. But we hate to break it to you – you are in it for the money. While it’s nice and commendable to provide some free care – your agency is going to become the dumping ground for unprofitable patients and patients that drive your quality scores down. Your reputation of never turning a patient away could actually be forcing your business into a death spiral.
Remember – it’s not just about the money, which is totally necessary if you plan on being in business for the long term – but it is about your outward appearance to stakeholders. Your quality statistics and your ability to stay in touch with what is going on within the broader community – not just in home health – are what will make you innovative and more attractive to other providers. These characteristics are going to help you become the agency of choice if you improve so you can be included in ACOs.
We speak to smaller agencies all the time about marketing, finances and operations. For smaller agencies we always get asked the same question, “What can you do to help us get more referrals?” When we ask the rebuttal question to the agency owner, “What makes your agency unique that makes referral sources want to select your agency?” and then we hear silence – we know that this agency isn’t really paying attention. If you, the agency owner, aren’t able to tell someone – anyone – what makes your agency clinically strong and why someone should refer a patient to you, without hesitation, then you need to reevaluate your strategy. The elevator pitch isn’t dead, but your agency could very well be if you aren’t coming up for air every couple of weeks to see what’s going on outside of your agency.
How are you going to become part of the next new ACO that is being formed? Well – you aren’t going to do it by hanging around in the office and waiting for the phone to ring. You are going to need to make a concise, executive decision – do you swim or tread water? Will you clear your schedule of excuses and begin to form two plans – one for holding clinical staff accountable with clear actionable items to improve your quality scores and two, a marketing plan that is revolving around you – no one else. A marketing team is great, but the agency owner makes a much better impression meeting with referral sources – but you do need to get out of the office to do that.
2016 is still fresh and so are we – so don’t waste any more time. Do something and don’t just wait around thinking that referral sources are going to send you patients based on your name, your location or perceived standing. You have the data – they have the data – don’t be fooled. Be prepared, be ready and then actually do it – don’t just plan and think – but actually do it.