SCALE Case Study:

Payer Strategy – Home Health Provider

Client Profile

  • Specialty:
    Home Health Agency

Services Deployed

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Payer Strategy

Market Positioning

Overview

SCALE was engaged by a home health service provider specializing in post-acute care to assist with payer contract review, rate negotiation, and market positioning across Medicare Advantage (MA) and Commercial lines of business.

  • The Client is a leading home health agency in orthopedic care recovery with over $16 million in annual revenue and accelerating growth in patient volume.
  • The Client receives physician, hospital and ASC referrals for post-operative patients to provide skilled nursing and home health physical therapy services to aid in recovery.
  • Post acquisition, Increased volume in orthopedic patient episodes and lagging reimbursement compelled them to seek improvement in payer contract performance.

Execution

SCALE Payer Strategy analyzed the home health market and their current payer agreements.

  • SCALE developed a rate negotiation strategy with consideration of the following:
  • Obtained clinical and performance outcomes from the group to quantify savings to the payer
  • Assessment of current payer agreements with respect to rates, geography, nationally and service type provision.
  • Client’s positioning within the context of national home health market movement, payer acquisitions, as well as payment methodology.
  • Obtained data from market stakeholder views on home health services as a factor included in the strategy.

Results

As a result of payer negotiations, commercial rates have increased consistently with three
major payers with material increases and favorable contract terms.

  • SCALE assisted the Client in meeting with payer representatives to explain their value proposition and demonstration of high-quality patient outcomes in post-acute care.
  • The group’s contracts with 2 other payers are now in ongoing negotiations for more favorable rates and contract language.
  • SCALE is proactively coordinating the negotiation of other contracts for 2024 based on contract renewal timelines.

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