The High Stakes of Post-Hospital Care

The transition from hospital to home can be one of the most critical and challenging periods in a member's care journey-where the right services at the right time can mean the difference between recovery and readmission.

Many individuals find home health services, such as skilled nursing or physical therapy, essential to a smooth recovery. Delays in home health care can lead to a perfect storm of costly consequences for health plans and their members, including unnecessary readmissions, prolonged recovery times, lower Star ratings, higher costs, and diminished member trust.

Research shows that patients who wait more than two days after hospital discharge for their initial home health care visit face a 12% higher risk of rehospitalization or emergency department visit.¹ These delays don't just compromise outcomes, they create a ripple effect that drives up healthcare costs and diminishes member satisfaction.

Delays Can Hinder Member Outcomes and Strain Health Plans

Despite the clear urgent need, achieving timely starts of home health care remains a significant challenge across the healthcare system.

Challenges that contribute to this problem and can jeopardize a member's health include:

• Staffing Shortages: Many home health agencies, despite becoming more efficient with care delivery, have trouble meeting demand, leaving members without care when they need it most.
• Equitable Care: Health plans may struggle to provide adequate coverage, often leading to devastating consequences, especially for members who live in rural areas.
• Provider Network Inefficiencies: Networks that are not optimized for adequacy and quality fail to meet members' unique needs, leading to delayed starts of care, member dissatisfaction, and higher costs.

In fact, 34% of home health services experience delayed starts of care.²

When timely starts of home health care are not achieved, the ripple effects are felt across the entire healthcare system:

• Higher Costs: Avoidable readmissions can drive up unnecessary healthcare spending. The average cost of a readmission is $16,037 per member.³
• Worse Outcomes: Delayed starts of care can result in complications or prolonged recovery for members.
• Member Dissatisfaction: Negative experiences during transitions of care may harm member retention and impact health plan reputations.

Ensuring Timely Starts of Home Health Care

Timely starts of home health care offer a significant opportunity for health plans to improve member outcomes, reduce costs, and enhance member satisfaction.

At CareCentrix, we've built a Home Health solution that provides our clients savings not only on home health services, but overall healthcare costs by coordinating and managing each episode of care while meeting members' care needs in the comfort of their homes. Services include skilled nursing, physical, occupational and speech therapies, medical social workers, and home health aides as appropriate.

Here's how we facilitate access to a high-quality network of home health services:

• Robust Network Management: CareCentrix curates and manages a high-quality, national and local provider network, coordinating home health for members leaving the hospital or members with chronic conditions that may need ongoing services in the home-ensuring seamless care coordination, even in rural or underserved areas.
• Timely Access: We deliver appropriate, coordinated, and timely access to quality home health services, achieving 99.7% on-time starts of care.⁴ Through HomeBridge®, our provider portal, our provider network shares data and insights with referral sources to help ensure timely delivery of care.
• Managing the Entire Episode of Care: We help members achieve better outcomes by addressing their unique needs throughout the entire episode of care. Leveraging our HomeFirst Analytics, we connect data and insights to match members to the right provider and evaluate the optimal level of services needed.

As a leader in home-based care for nearly 30 years, our approach has been proven to reduce unnecessary readmissions, improve member satisfaction, and save health plans money using multiple reimbursement methods.

Together, Let's Shape the Future of Home Health Care

Timely starts of home health care are a necessity for any health plan looking to deliver value to its members and reduce costs.

Are your members receiving timely home health services? And what would it mean for your organization if you could consistently achieve better outcomes and lower costs?

At CareCentrix, we're here to help you answer those questions and improve your home health strategy. Schedule a consultation to explore how our Home Health solution can help your organization enhance member outcomes and optimize costs - one timely start of care at a time.

Sources:

1. Journal of the American Medical Directors Association, 2022.
2. American Journal of Managed Care, 2022.
3. Healthcare (Basel), 2024.
4. 2024 CareCentrix book of business performance data. Actual results will vary depending on program. Results are based on prior program performance across all lines of business

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