Well being insurers sometimes should not have a transparent view of their members’ care after an acute well being occasion. Even when they do, many don’t belief the post-acute care supplier serving their member.

These findings come from a brand new survey of well being insurers performed by WellSky, a post-acute care know-how firm.

Particularly, the analysis revealed the next:

– Solely 37% of respondents (care plans) handle members in a post-acute setting after discharge from acute care. The bulk try and handle care internally somewhat than accomplice with suppliers or different post-acute networks.

– Solely 33% of respondents indicated that “the bulk” of their members are discharged to “excessive performing” post-acute care services.

– 43% of respondents stated they had been “reasonably assured” that their members would obtain the suitable degree of care after discharge.

The well being plan respondents – Medicare Benefit (MA) plans – ranged from 115,000 to greater than seven million members.

“These findings reinforce what we proceed to listen to from payers about how necessary it’s for MA plans to have better visibility and proactive affect over their members’ discharges to make sure they aren’t solely directed to the proper degree of care, but in addition to high-performing post-acute suppliers for a member’s particular situations,” Andy Eilert, president of payer and rising markets at WellSky, stated in an announcement. “It will assist plans obtain decrease total prices, improved high quality of care and improved member outcomes.”

That is notable info for residence care suppliers making an attempt to barter with MA plans at a better degree. High quality residence care can decrease the Medical Loss Ratio for well being plans. If these plans don’t have a lot visibility into the place their members are getting post-acute care—in different phrases, don’t have strong partnerships—or have members who’re utilizing substandard suppliers, there’s room for alternative.

Residence well being care suppliers who can construct a relationship with MA plans the place they’ll deal with a sure variety of sufferers in a specific market can negotiate higher charges or a greater fee association than they at present have.

That, in flip, may assist shut the hole between MA residence care charges and conventional Medicare charges.

Presently, greater than half of Medicare beneficiaries are in an MA plan. Final yr was the primary time ever that MA beneficiaries outnumbered conventional Medicare beneficiaries.

“As a result of it is a comparatively unmanaged space, MA plans are actually realizing the numerous alternative to enhance on this space and are searching for next-generation options that ship higher outcomes throughout the whole episode, together with readmissions,” Eilert continued.

As entry to residence care decreases, suppliers are gaining extra leverage within the relationship between themselves and MA insurers.

Well being insurers need “extra residence care,” not much less, CareCentrix CEO Steve Horowitz informed Residence Well being Care Information earlier this yr.

In line with WellSky information, between 25% and 30% of hospital admissions are avoidable. Well being insurers are leaving cash on the desk.

“There are numerous challenges in terms of managing post-acute care, and we are able to not attempt to clear up them in silos,” Eilert stated. “We want options that convey suppliers collectively in an built-in, value-based mannequin to proactively handle these sufferers from acute to post-acute care to residence, together with stopping hospital readmissions.”