Why a Value-Based Personal Care Model

By David Adams, Help at Home SVP, Payer Contracting and Relations

Throughout my 25+ year health care career, I’ve seen an evolution of value-based care programs. It’s my belief that our system will continue to retain some fundamental fee-for-service elements, but as CMS and states across the country understand and emphasize the benefit of home care as the center of health care, we’re moving toward a more meaningful value-based model. And, as we better connect health care to home care through innovative new payment models, we see proof that the model is working to positively impact quality of care and cost outcomes.  

At the core of Help at Home’s value-based philosophy is payment innovation that goes beyond the traditional fee-for-service model with a vision to change the way personal care services are delivered in a much more integrated, wholistic way. And that includes value-based programs which we know impact cost and quality outcomes for the better. 

We’re creating operating platforms that are streamlined and efficient to ensure our administrative functions are centralized and not fragmented, as this will successfully support our growth strategy, improve our partnership programs, keep our caregivers focused on taking care of our clients, and moving to the idea of a reimbursement system that goes beyond fee-for-service.  Our ultimate goal is keeping clients in the home to age-in-place as independently at home. 

Seventy percent of our business flows through some type of managed care, Managed Long-term Services and Supports (MLTSS) program. And we’re seeing 25%+ of our client-base in value-based care programs today with continued expansion. With the growing demand from our aging populations for home care, states are focused on Medicaid managed care as a solution to produce better health care outcomes by connecting home care and health care.  

These partnerships allow us to deliver outcomes that provide value beyond just delivering our core personal care and homemaker services. As we think through our value for MCO partners, states and at-risk provider groups, our position as the largest Home and Community-based Services (HCBS) provider allows us the ability to build tech-savvy capabilities. Coupled with our size, scale these technological capabilities distinguish us as an innovator and leader in the value-based space.  

One of Help at Home’s core strengths that sets us apart is our 60k+ caregivers taking care of clients in their homes every day — an average of 20+ hours per week. That time spent in the home leads to building long-standing client relationships, as well as observations that we can analyze, act and impact as part of our innovative value-based partnership programs. 

Another strength is our centralized Contract Management System along with advanced analytics that enables us to collect powerful data analytics for a broader operational view and scope of the impact of our clients’ Social Determinants of Health (SDoH), Health-related Social Needs (HRSN) along with our unique care management program that identifies a direct pathway for each client to connect home care to health care. 

Our Care Coordination program is one of the best and most effective programs that I’ve seen in my career. To put it simply, the program wraps a comprehensive clinical layer of support around our personal care services that connects clients to their health care system, helping to solve for SDoH, one of the largest drivers of health care costs. We’ve seen impactful quality outcomes client-by-client. The outcomes data is revealing measurable impacts on impatient and ER utilization reductions by 50% as an example — which is powerful. By synchronizing our home care programs to the broader health care system, we’re reducing overall medical costs and creating win-win-win situations for all, including clients and payers.  

We’re proud of the work we’ve accomplished and are looking forward to the future as we advance our industry using our experience, expertise and long-standing culture of caring.  

David Adams is a senior vice president of payer contracting and relations. He holds both a Doctor of Pharmacy from Virginia Commonwealth University’s Medical College of Virigina and an MBA with a concentration in healthcare management from the Wharton School of the University of Pennsylvania.