As noted in Part 1, nursing homes will continue to be a critical piece of the long-term care industry. But more Americans will seek less restrictive options for senior care in the future, and at the top of this list is home health care.
So, how does a traditional long-term care pharmacy begin to establish a presence in at-home care? Some pharmacies have decided to do it alone, while others have built relationships with home health agencies (HHAs). There are advantages to each approach, but collaboration may offer a more strategic advantage for LTC pharmacies.
Efficient pharmacies have leveraged automation to dispense large quantities of medicines with remarkable accuracy. Mail order and LTC pharmacies have led the way in simplifying and reducing costs from the dispensing process. As a result, expectations from payers and regulators have been raised.
Public payers like Medicare and Medicaid as well as private payers will continue to reduce reimbursement for the act of dispensing prescriptions, limiting it as a pathway for business growth.
Can any of us hope to compete with Amazon on price? Probably not. But our industry wasn’t built on a mentality of discounting a commodity.
The LTC pharmacy industry was built by bringing a professional focus on appropriate, personalized care, improving nursing homes' ability to manage resident prescription drug regimens. The Nursing Home Reform Act of 1987 made nursing homes responsible for ensuring residents had appropriate pharmaceutical care, and nursing homes contracted with specialized pharmacies to deliver these services. Our ability to enhance patient care remains as valuable as ever, and it’s adaptable to new modes of service.
HHAs are reimbursed differently by Medicare and Medicaid, but unlike LTC pharmacies, home care companies’ primary source of revenue is from private payers. This is starting to change, as HHAs are seeing agrowing percentage of revenue coming from the public sector. However, since most consumers of home health services are Medicare or Medicaid beneficiaries, the drug benefit is provided by a source with which we have considerable experience: Medicare Part D.
The opportunity for a mutually beneficial relationship is compelling. We’ve become experts at navigating the Medicare drug benefit and have long been proficient in managing Medicaid reimbursement issues. HHAs have far more experience in the private payer market than we do. Maybe we can learn something from each other and provide a real benefit to patients simultaneously.
While most patients using home health have drug coverage under Medicare or Medicaid, reimbursement outside of institutions can be challenging. CMS requires Medicare plans to have LTC pharmacy networks. In the past, the required services in Medicare only applied to residents in qualifying institutions. But with the recognition of (MAH) services by CMS in 2021, LTC pharmacies finally have some guidance on Medicare Part D dispensing fees to include additional costs for specialized services.
However, as it currently stands, LTC home care services do not reflect the level of care being provided. LTC pharmacy industry groups are working to improve reimbursement policies to better support the true costs associated with delivering these services in home care settings. We will get there eventually, but the challenge will be to provide these services with limited typical Medicare reimbursement.
We know who our target facilities are in our service area. We are probably speaking with nursing home executives on a regular basis to try to win new business. HHAs are not as familiar to us, so we have homework to do. We need to discover where they’re located and begin getting to know them.
Expanding into new arenas can be daunting. As an LTC manager, you’re an expert — you are used to people coming to you for advice. Venturing into a new area like home care puts you into the role of a student. That is often a challenge for senior managers.
Maybe the best way to get started is just to start. Begin finding HHAs in your service area and see if you can schedule some time to meet with the most senior person you can identify. Try a low-key approach such as, “I don’t know much about home health, but I want to learn. I think there may be an opportunity for us to work together. Any chance we can meet and talk?”
This evolution is still in its early stages – but getting started now will pay dividends sooner than waiting ever will.
You can learn more about home health care (HHC) and home health agencies (HHAs) by checking out our podcast episodes below with guests Lindsey Dymowski and Paul Shelton. Both give insights on providing home health care services.
Also, join us at the 2024 AmplifyLTC Pharmacy Conference, where Lindsey Dymowski and Paul Shelton will speak on Opening Closed Doors to Home Health Care.
