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Topics may range from “Connecting a care team to effectively implement an individualized education plan” to “Elder-specific issues in care coordination.” We think unlocking potential and enhancing care outcomes includes keeping everyone informed of new and better ways to organize and coordinate care in patient-centric ways…

Insurance Companies Are Frustrated by In-Home Care Agencies' Lack Of Data

In-home care agencies are well on their way to expanding services as the silver tsunami continues to build speed across America. With good reason; the aging baby boomers’ health continues to decline, and with it, the need for in-home care continues to rise. The most significant difference with this generation compared to those before it is the household with two full-time career parents.

The ability of the family to help mom or dad age in place is not as doable as it was in decades past. With two parents in a family working, there just isn’t time to adequately care for someone in need of in-home care. In-home care agencies could grow considerably over the next 10 to 20 years, but their services aren’t covered well with most insurers if at all. Why is that?

Insurers do feel a moral sense of responsibility to care for the general public with the insurance plans they provide. Still, they are a business and making a profit off of what they offer is what they are in business for. This push-pull creates a lot of tension between the insurer and their members. Many older insurance plan members are frustrated with the lack of coverage with in-home care agencies and the services they provide.

In-home care is expensive, and those on a fixed budget struggle to pay for what they need to live, never mind be cared for. Most can agree that aging in place is a lot less expensive for all than being placed in full-time skilled nursing facilities. So what is the hang-up with providing in-home care agencies with the contracts they need to bill insurers for what they do for their members?

In-Home Care Agencies Have Not Been The Best Data Collectors

Insurers are still trying to discern what the ROI is for being able to allow in-home care agencies in-network as billers. There is a need, but to what end? For the insurer’s perspective, in-home care needs to be more than a value-add for plan members.

Being able to collect meaningful data from in-home care agencies on what the financial benefits are to an insurer enough to make them want to offer to cover these kinds of services has been practically non-existent. The type of information that in-home care agencies are contributing to the insurance world on what their benefits are for coverage is not what insurers need to justify the cost of coverage.

Secondly, the collection of data by in-home care agencies as been disjointed at best. Most in-home care agencies are small, family-owned businesses. Finding in-home care agencies with technology sophisticated enough to run reports on to produce the kinds of data reports insurers are looking for is difficult.

Most small in-home care agencies are not making these kinds of investments in their business. That is, until now. The need for data collection to be accepted into health plan coverage and Medicare Advantage is driving the need for better data collection. Many advancements in technology that would benefit in-home care agencies is coming to fruition.

Smaller in-home care agencies are still relying on paper forms and patient folders to keep track of records and data. This archaic means of recordkeeping prevents in-home care agencies from being data accessible to the insurers they would like to cover them. For in-home care agencies to be more competitive in the near future, they’ll need to adopt technologies that allow insurers to do business with them effectively.

Paper client records don’t allow anyone easy access to patient information, thus hindering proof of care and patient delivery of services and outcomes. Insurers need to see progress and patient outcomes to continue to cover services. In-home care agencies will need to adapt to how insurers do business with service providers to take advantage of being in-network and able to bill for services.

In-Home Care Agencies Can Do Better With Data Starting Today

The best question an in-home care agency could ask a potential insurer is, “How will you know if we are a benefit to your plan members?” Starting with success questions lets the in-home care agency know what kinds of information the insurer is looking for to collect it for proof of success.

Secondly, the digitalization of client/patient records and accessibility to that information for case managers at insurers is essential for being part of their benefits offerings. Case Managers need to effectively assess outcomes in order to approve services being billed for. The easier that job is to do, the better the provider/insurer relationship goes and even continues.

eCare Vault is one of the first solutions of its kind to be able to help in-home care agencies be able to deliver the data needed to help with getting in-network with insurers and Medicare Advantages new RAP program. eCare Vault is completely EHR agnostic, allowing every in-home care agency, insurer, medical practice, and/or clinic to work seamlessly together toward collecting the data necessary to ensure the best patient care and outcomes.

If you’d like to do better with data collection and helping insurers understand the value you provide to them and their members, contact us today for a free consultation.

Thank you for sharing!