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The Health Innovators Show: Best Practices for Selling to Healthcare Payers with Brian Lobley

In this episode of Health Innovators, Dr. Roxie Mooney interviews Brian Lobley, CEO of tango. Brian shares his journey from Independence Blue Cross to leading tango, emphasizing value-based care in the post-acute space. He provides best practices for selling to healthcare payers, including understanding attribution, setting measurable success metrics, and having a robust implementation plan. Brian highlights the importance of partnerships and co-creation in developing successful healthcare solutions. Listeners will gain valuable insights into navigating the complex payer landscape and strategies to enhance their approach to engaging with healthcare payers.

Key Takeaways:

Understand attribution and set measurable success metrics for effective payer engagement.
Develop a robust implementation plan to ensure smooth execution and adoption.
Foster partnerships and co-create solutions with stakeholders for continuous innovation and better outcomes.

The Compliance Guy Podcast: Brian Lobley, CEO of tango

Check out our latest podcast on The Compliance Guy, where we dive into the evolution of tango. Hear Brian share his experience running a 5-star Medicare plan at Independence Blue Cross and explore the cost pressures in post-acute care, challenges payers face, and the importance of value-based care models. We discuss bundled rates, rewarding providers for reducing ER visits, and shared savings, as well as the differences between traditional Medicare and Medicare Advantage. Learn about tango’s commitment to ensuring access to quality care, our focus on preventative care, outcome measurements, and our vision for the next 5-10 years. Plus, discover how we manage a robust compliance program and our business lines across Medicare, Medicaid, and Duals.

HealthBiz: Revolutionizing Home-Based Post-Acute Care w/ tango CEO, Brian Lobley

Listen in as Brian Lobley, the innovative CEO of tango, joins HealthBiz podcast host, David E. Williams, to unravel the complexities of post acute care and its crucial role in patient recovery and healthcare economics. Brian shares his journey from his Philadelphia roots to reshaping healthcare through technology (with a passionate nod to Philly sports teams along the way).

Together, Brian and David explore tango's mission to revolutionize home-based care for seniors, especially within the Medicare Advantage space, and how this aligns with the growing preference for patients to recuperate in the comfort of their own homes, potentially reducing costly hospital readmissions.

As the conversation unfolds, we examine the transformative potential of redirecting resources from financially strained hospitals to more community-centric and home-based healthcare services. We dissect the intricate balance between the need for accessible critical beds and the service demands of diverse patient demographics, encompassing Medicare Advantage, commercial insurance, Medicaid, and dual eligibles. David highlights the vital role of patient and caregiver engagement in the realm of home health, and Brian sheds light on the importance of effective communication and robust support throughout the continuum of care.

Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams

Vistria-Backed Value-Based Care ‘Enabler’ tango Helping Providers Get Paid For Total Cost Of Care

By Joyce Famakinwa | February 7, 2024

tango is on the front lines when it comes to re-defining the dynamic between home health providers and conveners. So much so that the company has dropped the convener descriptor and instead considers itself an enabler.

“We’re really after ensuring that providers and payers, or risk-bearing entities, are aligned, and driven to the same objectives,” tango CEO Brian Lobley said during the latest episode of Home Health Care News’ Disrupt podcast. “At the end of the day, that is a total cost of care in the post-acute continuum.”

During the conversation, Lobley also talked about how tango is making sure home health providers are getting compensated for the total cost of care and the synergistic opportunities that come with being backed by The Vistria Group.

tango is a post-acute enablement managed service organization that takes on full risk from payers. The company is fully delegated for claims and for network for utilization management.

The company has also formed relationships with several top home health providers, including Amedisys (Nasdaq: AMED), LHC Group, Compassus, Enhabit (NYSE: EHAB) and more.

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HHCN: tango has called itself the “anti-convener,” and last time we spoke for Home Health Care News, you described the company as an “enabler” rather than a convener. What does this mean? Can you talk more about this?

Lobley: We are very deliberate about that term. Typically you look at the definition, conveners are all brought together to talk about a problem. Enablers really come together to solve a problem, and that’s what we’re really after. We’re really after ensuring that providers and payers, or risk-bearing entities, are aligned, and driven to the same objectives. At the end of the day, that is total cost of care in the post-acute continuum.

Too many times, what we’ve seen in the marketplace, historically, is a focus on utilization management. “Let’s make sure we’re putting a laborious administrative process in to get post-acute services approved.” That’s not what we’re looking at. We know that our high-quality network provider partners are focused on ensuring a patient stays home, and recovers at home.

They’re in the best position to determine how many skilled home health visits a person needs after an inpatient setting. Maybe they had a hip-replacement surgery, [and] they’re an 85 year old polychronic patient. That’s going to be a much different profile than someone who’s 66 years old, getting out of the hospital with a hip replacement. We want to make sure providers have the latitude within a value-based payment construct to deploy the right amount of visits and services, and overhead to the patient, so that ultimately, they’re recovering at home. They’re avoiding those things I talked about previously, which is popping back into the emergency room, or unfortunately having to be readmitted.

This idea of being an enabler, means not only do we enable the payer strategy of providing high-quality post-acute services; we’re enabling the providers to allow them to do what they do best, which is caring for patients. We’ve embraced the term enabler. We do think it’s a new category of sorts, because we’re also only about taking full risk. So that notion of being fully delegated, taking full-network risk, taking full utilization management risk, and ultimately paying those claims is really different for us.

Lastly, the point that really differentiates us is we go up into the discharge process, and we actually control the referral. That is where placement of services is most critical. When someone needs home health services, it starts with a referral from a physician. That referral creates an authorization, and that authorization ultimately is a claim being paid. Most folks in this space, in the industry, really pick it up at that authorization. Service has already started, they’re approving how many visits. We take that early in the process at discharge. We manage the referral, which means we work hand-in-hand with the patient.

It’s critically important to get a nurse within the home in the first 48 to 72 hours to make sure that they’re, ultimately, going to recover at home. Being upfront to add that process – and, then, enabling provider and payer strategies – is why we’ve kind of embraced the anti-convener tone.

I don’t think it’s unfair to say that home health providers and conveners often have a difficult relationship. How has positioning tango as an enabler rather than a convener impacted the company’s relationships with home health providers?

I think it has, and I welcome anybody to talk to our provider partners, and they’ll tell you the tango difference.

We’re spending time with providers making sure we understand their workflow; how do we make their workflow easier on an administrative basis? Today, in a post-acute environment, it is much more laborious to handle a managed care patient, so a Medicare Advantage patient versus a Medicare fee-for-service patient. We’re trying to understand those differences from an administrative process standpoint, and trying to simplify that for our provider partners.

One way to do that is to ensure that every referral they receive from tango is already qualified. They don’t have to go chase down eligibility, or diagnosis codes. That comes over directly from us. We’re reducing that paper-chase burden that happens.

We’re simplifying that, and then going into prospective payments, episodic payments, and ultimately value-based payments. We’re really focused on allowing them to get compensated for the care. We’re not trying to pay them on a fee-for-service, per visit basis – getting paid for every visit, then fighting over “do you need a third, fourth, fifth sixth visit.” We’re paying episodic.

I use my example of those two different patients: a 66 year old, single-condition hip replacement patient, and an 85 year old polychronic. It goes without saying, the 85 year old polychronic patient probably needs more visits. We’re going to, again, pay them an episodic rate, so they can manage maybe 15 visits for the 85 year old, but maybe only three or four visits for the 66 year old.

By really empowering them to do what they do well, and making sure they’re compensated for that, it changes the dynamic. It gets away from, “I’m trying to restrict you on visits and manage you to an episode count,” [and moves] to “I’m trying to empower you to ensure that patient has recovered and stayed well at home.”

We spend time with providers. We do co-design sessions with them. We understand if their workflow is different from provider to provider, maybe geography to geography. How can we modify our system? How can we provide more data to make them be more effective at their job? Approaching this in a team-sport mentality is important for us. Therefore, we can’t be in an antagonistic relationship. We have to be in a partnership-oriented relationship, and that has resonated, to date, with our provider partners.

Moving away from the descriptor of convener and embracing enabler was part of a big rebrand that we also covered for HHCN. The rebrand began in 2022, when the Chicago-based private equity firm The Vistria Group purchased a majority stake in the company. What has The Vistria Group’s investment allowed the company to accomplish that wasn’t possible before?

Quite frankly, quite a few things. First, Vistria has an amazing reputation in the post-acute space, and has made a number of investments in the post-acute delivery space. They understand post-acute; they understand the provider side of the equation. What they noticed through a number of their assets, what was missing was an aggregated risk-based platform. They did a full due diligence across the network. They looked at all the “conveners” or “enablers” in the space. Ultimately, what they decided is this differentiation up there by grabbing that referral, allowed a company that was PHCN at the time, now tango, to move into that full-risk continuum to be able to really take that delegated full capitated risk from a payer.

What Vistria has allowed us to do is really spend the past year rebuilding our technology, our data analytics and infrastructure, and our provider-facing strategy to allow us to focus only on those value-based contracts going forward. We’re not looking at legacy models; we’ve been very fortunate to say “no.” If certain payers are looking to do something in a more legacy environment, it’s not the right fit for us. It’s allowed us to really be deliberate in our strategy. It’s allowed us to invest in a lot of new talent. We have a great team here at tango. We’ve brought in a lot of folks that have experience in the managed care business. We brought in more folks that have experience in post-acute, and we brought in folks that understand risk arrangements and delegated arrangements. We’ve been able to invest across the continuum in people, process and technology.

The Vistria Group has a portfolio of home-based care companies. Have there been any synergistic opportunities so far?

Quite a few that allow us to have immediate strategic conversations with Vistria home health providers.

We get, I’ll say, more accelerated, down the field into a partnership. We get to work with data analytics companies Medalogix, who’s also a Vistria portfolio company, to make sure we understand how we look at episodic risk, because providers are using it, so that we’re looking at the same information a provider is when they’re looking at a patient. The ability for the Vistria network and the power of that to accelerate us into market conversations has been critical.

Getting back to the rebrand, one thing tango wanted to focus on was going deeper into risk. How has tango done this?

What we’ve been able to do now is go to our payer partners, and we’ll look at a historical claim run. We’ll look at what their skilled home health usage has been over the past two to three years, depending on what data is available. We’ll be able to understand what percent of their membership is using home health services – great examples in Medicare, it’s highly geographic. The Pacific Northwest acts differently than the Northeast and the Southwest.

What are the utilization patterns? We’d like to see a home health utilization rate somewhere between 6% and 8% of a population. We’re able to baseline that spend. We’re able to trend that spend forward, anticipate what the next-year spend is going to look like, when unit utilization increases come forward. We’re able to pitch a full-risk model, so we take a PMPM cap rate from the payer. We take that on full risk, so we have a utilization quarter that we agree to. We’re full risk within that. We are then managing, as I’ve stated before, the claims, the network, the UM, all that financial risk sits with tango. Then we wrap that around with the shared savings programs. During that same claims run, we will actually look at each episode from a skilled home health standpoint. For example, we’ll create a baseline of what percent of those members are going to the emergency room within the home health episode, or are being readmitted back into the hospital during that home health episode. We’ll agree to a baseline on that model, and then we will drive down that percentage, and we will share those savings back. Certainly, we’re sharing those savings back with the payer, we’re making sure they get the benefit of the tango model and embedded care management model that works hand-in-hand with our provider partners. What we’re also doing is, really importantly, sharing those shared savings back with the providers, allowing those providers to participate in value-based arrangement, which is critical today. We’re seeing that nearly 50% of the market is managed by Medicare now, so Medicare Advantage has become the predominant payer [among] seniors for example. Moving that shared risk value-based arrangement has been critical for us, so that’s where we differentiate ourselves on a full risk basis.

Your company has a number of partnerships with some big home health companies — Amedisys, LHC Group, Compassus and Enhabit to name a few — what are the keys to successful partnerships in your view?

The first is listening; each of those companies you mentioned, and all of our other partners, aren’t all the same. They have different business processes. They have different expertise. They’re different within each market. Our co-design session starts with a listening tour. Let’s make sure we understand how you’re performing in a specific market. Let me make sure that I understand what your market differentiations are. How do we best integrate with a centralized function? Some of them may be decentralized in each specific geography. How are we working across each of those geographies to make sure that we’re integrating into their business process workflows?

Then it’s making sure they understand the value-based components: a transparent sharing of information, so that they understand how they can achieve the shared savings targets. What are the expectations going into each market activation that we complete? I think the tone and tenor has been all positive. We’re looking to make sure we get total cost of care contracts. We’re looking to make sure we’re participating in value-based provision. I think that’s been the real key for us, is making sure we understand and are empathetic to the business challenges they have. There’s a labor shortage that they have on the home health, nursing care side. We want to make sure that we’re reducing as much burden as possible and making sure a tango member is a member that they want to see.

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Post-Acute Care and Enablement of the Home, An Industry in Flux

Post-acute care is the process of enabling functional recovery, following an acute or inpatient admission. Many settings can be used to support post-acute care, including Skilled Nursing and Rehabilitation facilities, but often, the most preferred setting for care is the home.

Older Americans, with Original Medicare and increasingly Medicare Advantage health insurance coverage, represent the lion’s share of patients seeking post-acute care. While their preferences for recovery at home are clear, there are barriers to fully enabling the home, despite data that suggests the home can be a more efficient and higher quality site of care for recovery that also improves total cost of care, including costly re-admissions and inappropriate emergency room utilization.

So why then, has post-acute care, particularly the use of skilled home health, lagged consumer preferences, especially the wishes of Senior Americans? The answer is complex, but there are several factors working against this goal.

Though skilled home health has been around for decades, labor pressures, especially following the pandemic, continue to rise, and nursing shortages remain at an all-time high. Quite simply put, there is not enough skilled labor to support the demand for home health. WellSky, a leader in post-acute care software and analytics, suggests 40-60% of physician-ordered home health care referrals are going unplaced.

For Medicare Advantage members, access is even more complicated by reimbursement issues. Today, Traditional Medicare is a better payer for services than Medicare Advantage plans, which are private plans offered by health insurance companies as an alternative to Traditional Medicare. Medicare Advantage plans often include low cost to no cost premiums, with additional supplemental benefits such as vision, dental and health care allowances. These disparities in reimbursement are a conundrum the industry must solve, as Medicare Advantage enrollment and market penetration is at an all-time high of 48% and expected to go as high as 60% by 2032. The industry must do better to ensure that these Americans do not slip through the cracks and can be offered similar level of access and service as traditional Medicare beneficiaries.

The expansion of value-based reimbursement solutions to post-acute care is a significant opportunity to reduce disparities in payment between Traditional Medicare and Medicare Advantage members and offer more meaningful solutions for increasing MA access to home health care. By rewarding providers for reducing total cost of care and sharing savings from lower readmissions and inappropriate ER utilization, the industry can take meaningful strides to not only foster payment innovation but reduce disparities in access to home health for Medicare Advantage members.

The path to get there, however, will take work as the home health care provider landscape is fragmented. While several large national home health agencies exist to adequately serve most markets an enormous amount of regional and local agencies are also required, making the process of building value-based networks laborious.

The evolution of new tools and technology to better support how we deliver home health care and support agency success in value-based arrangements will also be important. Enabling home health care providers, particularly given the labor pressures they face will be paramount, and tools that help refine our understanding of patient needs, simplify documentation, and administrative paperwork will be key. For example, two patients with similar home health needs, but with different comorbidities, caregiver, or socioeconomic needs, may require a different number of home health care visits and extra care coordination support to ensure they recover successfully in the home, such as assistance with appointment setting to ensure they have a ride back to their provider’s office for a follow-up visit.

The ability to predict a patient’s potential for an adverse outcome and to monitor their risk and health needs throughout their home health care episode, and in the period immediately following the conclusion of their home health episode, is also essential. Data collected from discharge notes, start of care assessments, progress notes during the home health episode, along with remote monitoring devices, and historical patient health data can all be better harnessed to help us better understand member needs, treatment plans, and risks.

Advancements in AI will also significantly advance stakeholders’ efforts across the industry and improve the way post-acute care is delivered. Imagine a world where large amounts of data can be summarized in near real-time to derive insights that could influence and inform more personalized treatment paths and recommendations for patients, such as referrals to Hospice and Palliative care, or to Care Coordinators to help patients obtain nutritious meals needed to bolster their recovery. Improving our understanding of a patient’s needs not only offers opportunity to improve care, outcomes, and patient satisfaction, but also allows the industry to better staff and plan for the care that is needed, ensuring that precious resources are optimized and deployed in the most effective manner.

While all these challenges may feel insurmountable, there is tremendous momentum already underway in the industry to tackle many of these problems. Collaboration across key stakeholders, including home health agencies, providers, patients, health plans, and post-acute care solution providers will be critical to fully enabling the home as a preferred place of care, and for ensuring that all Seniors, including Medicare Advantage beneficiaries, can utilize home for their recovery and health care.

Gaps in Home Care: Identifying challenges and tango’s solutions

When providing value-based, high-quality, and timely post-acute care solutions in the home, healthcare providers and networks have historically left patients unsatisfied and still in need. Whether it’s the patient experience or foundational service delivery obstacles, there persists a stigma surrounding the reliability of care in the home.

At tango, we empower the home as the site of care in everything we do. While acknowledging the stigma and sometimes a patient’s lack of trust when it comes to receiving post-acute care at home, our Chief Growth Officer, Julie Smith, notes a few of the key challenges currently hindering the expansion of Home Care across the greater health care industry, while also reiterating tango’s place as a critical and unique solution.

Access to Care

Ensuring a patient has access to home care is a fundamental challenge to providing services. Amplified by the COVID-19 pandemic, the United States is facing a shortage of registered nurses (RNs), which directly impacts a home health provider’s reliability of consistent service delivery. On top of that, McKinsey & Company recently reported that 31% of RNs were surveyed as likely to leave direct patient care positions in the next year. While tango does not directly hire patient providers such as nurses, our model encompasses a full network at each client’s disposal, efficiently connecting them with the highest-quality local and national partners.

Another challenge when it comes to accessibility of home care are the disparities in coverage and payment rates across health plans. It can be difficult for a health plan to select the “right” agency for a patient, which often creates an administrative burden. At tango, we have exclusively worked on delivering home care for over 20 years. Our tenure in clinical utilization management (UM), claims processing, paying providers directly, networking and monitoring, and more allows us to reduce fraud and waste within the administrative system while actively creating savings for members.

Quality of Care

Not all home care is provided equally. Across agencies, ensuring that a patient successfully receives home care services can mean vastly different definitions and practices. For some, it may mean providing services as quickly as possible and for others, it could be reducing the likelihood of readmittance to an acute setting. An all-encompassing model of value-based care solutions is where tango comes in. Continuously tracking the outcomes of our home care providers and using that data to learn where the gaps exist allows us to be consistent in our home care model. Additionally, after every service, we measure performance and use specific data to track every interaction with a patient. Through these thorough procedures of care, it is certainly no surprise that tango has a 98%-member satisfaction rate compared to the national average of 72%.

Timely Service Delivery

Timely initiation of care is one of the most important aspects of the care process and is directly tied to quality of care. Time is a clinical standard from the CMS, making it crucial for home health care services to swiftly provide patient care, guarantee improved post-acute care and reduce readmittance and hospitalization. At tango, we have many internal standards for timely service delivery. If our contracted agencies and partners are unable to respond to service requests according to our timeline, we adapt quickly and find another provider to guarantee a patient is taken care of as soon as possible.

While the home care landscape continues to evolve, Julie reiterates that it is our motto at tango, “enabling quality care”, that continues to be at the core of our service delivery. This mission remains true as we continue to develop innovative and unique solutions to mitigate challenges and obstacles to providing accessible, high-quality, and timely home health care services. We look forward to sharing new post-acute care products and partnerships in 2024.

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Home Health Care News’ DISRUPT Podcast: Interview with Brian Lobley, CEO, tango

On this episode of the Disrupt Podcast, Home Health Care News reporter Joyce Famakinwa caught up with Brian Lobley, tango CEO, to discuss why tango considers itself an enabler instead of a convener, and how this has allowed the company to form strong relationships with home health providers.

Listen to this episode of Disrupt to learn:

— How tango is building relationships with home health providers
— How The Vistria Group’s investment in tango has pushed the company forward
— How tango is going deeper into risk
— And more!

Disrupt · Brian Lobley, CEO, tango

How tango Is Working To Fix Home Health Care’s Convener Problem

The prickly relationship between home health providers and conveners is the industry’s worst kept secret. While some conveners are taking steps to improve these relationships, tango is trying to follow a completely different model to reach its goals.

The company, which once dubbed itself the “anti-convener,” has now positioned itself an “enabler” rather than a convener.

“We’re really trying to change the nomenclature of what we do away from convener,” tango CEO Brian Lobley told Home Health Care News. “Conveners certainly bring people together, but we like the term enabler, because enablers are actually facilitating the solution. That’s what we’re trying to do at tango.”

As an organization, tango forms partnerships with providers and health plans to offer clinical care management services.

The move to embrace the role of enabler is part of tango’s rebrand, which began last year when the Chicago-based private equity firm The Vistria Group purchased a majority stake in the company. The company used to operate under the name Professional Health Care Network.

“We wanted to usher in a new chapter of the company,” Lobley said. “We wanted a brand that signified partnership in the market. We wanted a brand that was memorable. It takes two to tango, and we’re firm believers that health care is a team sport.”

The Vistria Group realized there was a gap in the market for an organization that could help improve Medicare Advantage (MA) plan and home health provider relationships.

“At one point we said, ‘How come there’s not an MSO type structure in the home health care space helping these agencies embrace [Medicare Advantage] and value- and risk-based care,’” Nick Loporcaro, senior operating partner at The Vistria Group, told HHCN. “What they’re relegated to in the current environment is a lot of utilization management.”

Conveners typically serve as go-between for home-based care providers and MA plans, often dealing in utilization management, much to the chagrin of the providers.

In recent years, providers have expressed frustration at conveners taking a chunk of low MA rates and acting as unnecessary gatekeepers.

On the flip side, tango is focused on making sure providers are getting compensated for the total cost of care, according to Lobley.

“Our model predicates on still taking risks from the payer, so we are still delegated for network, we’re delegated for claims and were delegated for utilization management,” he said. “What we really do is turn around and say, ‘Let’s make sure the providers are getting compensated for keeping members at home, out of the emergency room, in a home health visit and certainly out of readmitting.’ We’re trying to make sure they’re being brought to the forefront of reimbursement for the holistic care they’re providing.”

The company’s contracts with payers are generally value-based. These contracts ensure that tango is baselining what a readmission rate is for home health patients.

“If we take a Medicare Advantage segment with a payer, we will look at what percentage of home health patients are winding up in a readmission scenario in a baseline period, how many of those members are lining up in an emergency room, and what we will do is we will go and say we will take accountability for reducing those visits,” Lobley said. “If 30% to 35% of home health patients are winding up in a readmission scenario, how do we make sure that we are enabling the home health provider to keep that person in the home? We put a care management layer underneath our solution, so that we’re tracking members after each visit.”

tango wants to make sure home health providers feel like actual partners in the relationship.

“It’s a kind of a symbiotic relationship between us and the provider, to make sure that we’re both having the same objective, which is to keep the patient at the center of what we’re doing, keeping the patient healthy and healing,” Lobley said.

Part of being a more home health-friendly alternative to traditional conveners is engaging in more transparent conversations.

tango also looks at its providers’ presence in today’s market, how much capacity the provider has and what strategies they have in place to serve patients between visits.

The goal is to keep any of the provider’s patients from falling through the cracks.

“We can interact with a central monitoring agency,” Lobley said. “And we’re seeing a patient trending negatively, so we’re making sure we share that information with the provider.”

tango adjusts its model based on the provider it’s working with. For instance, smaller providers may have different needs in the partnership than larger providers.

“We’re engaging them in the very same dialogue to say, ‘How do we facilitate that full 360-degree view of the member from an information standpoint?’ And, maybe in that case, we’re the release valve,” Lobley said. “tango’s care management team is the one that can get the first call from the patient if there’s an escalation or an intervention needed. The beauty of our model is that our bespoke nature allows us to dial-up or dial-down our care management function, depending on the sophistication of our provider.”

Currently, tango works with Amedisys Inc., LHC Group, Compassus and Enhabit Inc. (NYSE: EHAB), among many others.

Ultimately, Loporcaro hopes tango can re-define what it means to be a convener, and position providers for success.

“This is pioneering — we want to be that partner of choice for the home health care agencies, as well as the partner of choice to the payers,” he said.

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Q+A with Brian Lobley

October 2023 marks one year since Brian Lobley joined tango as our Chief Executive Officer. We sat down with Brian to reflect on his background in healthcare, his first year at tango and how he envisions the future of home care.

While this may be your first anniversary at tango, you spent almost 20 years working on the payor side of healthcare. How has the transition to tango changed your understanding of what value-based care means from a different part of the healthcare ecosystem?

Brian:In my nearly two decades working within the payor side of healthcare, I developed a deep appreciation for the intricate dynamics of value-based care and aligning stakeholder needs. I have been very fortunate to be involved in some very innovative value-based care models in Philadelphia, and the results we produced to enable better outcomes for members at a lower cost were meaningful, and in my opinion, critical to how we are all working to change the way US healthcare is delivered.
This experience has been invaluable in shaping my understanding of the work that tango is leading today. My transition to tango, which is leading the industry in driving value-based care arrangements across the post-acute continuum, has underscored the multi-faceted nature of value-based care and the importance of collaborative partnerships and alignment.
Today post-acute care, in particular, the home, is not fully enabled as a site of care for people, especially our Seniors in Medicare Advantage plans. The landscape is fragmented, there are many competing sites of service, and while the home is very often the patient’s preferred place to recover, it may not always be utilized, even when it’s a possibility. That’s where tango steps in - our mission is to enable quality care at home across the post-acute continuum.

Reflecting on this past year, what has been the most exciting moment or accomplishment with tango? What challenges do you anticipate as you look to next year?

Brian: I think our re-brand really encapsulates many of our key accomplishments this year as we pivot from being a company that was primarily focused on Home Health care to one that is able to drive and coordinate care across the post-acute continuum with a focus on enabling the home as a primary destination (when it makes clinical sense for the patient).
There are significant challenges in our industry. Home health agencies are facing tremendous labor pressure and there are not enough nurses and other care staff to meet the need. Care is also not being optimized for carriers serving Medicare Advantage members, where as much as 60% of home health referrals are going unstaffed. This means that patients discharged from the acute setting are not getting the critical care they need when they go home, which can lead to suboptimal outcomes such as unnecessary rehospitalization and emergency room visits.
This is why the tango model is so critical. Not only are we working hard to increase access for our members by being a preferred partner to home health agency providers, but our model focuses on working with patients while they are still in the hospital to get them placed with one of our high-quality providers. This ensures timely start of care and that care coordination services are provided during the recovery period to drive the best outcomes for our payors and their members.
We understand the challenges in our industry are multi-faceted, ranging from regulatory shifts to staffing shortages and increasing demand for home health services. Our distinctiveness lies in our agility and ability to adapt swiftly and work with all key stakeholders (payors, providers, patients) to refine solutions needed to respond to the evolving landscape. Our strength lies in our ability to transform obstacles into opportunities, and we are confident that tango can be a leader in changing the way post-acute and home care is enabled in this country. I’m also really proud of our team and their unyielding focus in helping to position tango to address the unique challenges that are facing the home health care industry.

What does the company name, tango, mean to you?

Brian: Just like in healthcare, the tango is an intricate dance that requires collaboration to be not just successful, but to produce beautiful “outcomes”. The dance’s beauty emerges as two partners connect, conveying emotion and connectedness through their deep attunement to one another. The ‘tango’, like healthcare, encapsulates the essence of how these dancers are working together - communication, adaptability, creativity, innovation, practice, mastery, leadership, and performance.
When seeking a brand to encapsulate this synergy, tango emerged as the fitting choice. Just as the dance requires two partners, our work in the post-acute care ecosystem relies on collaboration between us, payer partners, and providers to ensure patients access high-quality, cost-effective care. tango symbolizes this partnership, reflecting our commitment to working harmoniously to enable better care for patients within this healthcare landscape.

Looking to the future of home care, how you would like to see tango, as well as the home health care industry, innovate?

Brian: tango wants to ensure care the home can be accessible and available for members. Growth in the popularity of care at home is only going to increase as more and more “provider” services move into the home. We need to make sure the supply can meet the demand, the home is optimized as a site of care, and that the value generated from providing care at home is appropriately shared with the providers who are helping us drive better care for our patients.

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CMS FINAL RULE 4201-F: What to Know

At tango, we know that high-quality home health care services are essential to ensuring optimized post-acute outcomes. In an ever-evolving industry such as healthcare, there are many challenges and changes that companies across the healthcare continuum face in order to ensure everyone can receive access to consistent, timely, and elevated quality of care. These include rate cuts, access issues, and regulatory changes from the Center for Medicare & Medicaid Services (CMS).

This past April, CMS issued Final Rule 4201-F that went into effect as early as June and will continue to have various effective dates for contract years 2024 through 2027. While changes and additional amendments to regulations are not uncommon, these adaptations are important to note within the home health care space and industry at large. Since these CMS policies are aimed at ensuring that beneficiaries have consistent and timely access to medically necessary care, it is important to understand a broader scope of impact across the health care network.

Here, we breakdown 4 of CMS’ recent adjustments in their efforts to increase oversight of Medicare Advantage (MA) plans to further align with traditional Medicare coverage and what that means across the health care service provider network as they begin to take shape into 2024.

Ensuring Timely Access to Care

The Final Rule outlines requirements for utilization management (UM) regarding patient coverage and the practice of prior authorization. New guidelines ensure people with MA plans receive access to the same medically necessary care they would receive in Traditional Medicare. Prior authorization policies are used to confirm presence of diagnosis and to ensure a service is medically necessary. If a beneficiary is undergoing an active course of treatment and switches from traditional Medicare to an MA plan or switches to a new MA plan, the plan will provide a minimum of a 90-day transition period to avoid disruption in care. Such changes will strive to ensure that consistent care is accessible to patients no matter the status of their MA plans.

Protecting Beneficiaries

New measures to protect beneficiaries include the establishment of a Utilization Management Committee to review policies on an annual basis and ensure consistency with Traditional Medicare’s NCDs, LCDs, and guidelines. Aside from UM practices, another protection measure will include countermeasures for misleading marketing practices targeting patients. Moreover, these changes are in-line with efforts to increase transparency and the understanding beneficiaries have relating to their plans and coverage. Notification requirements to beneficiaries means that if a contracted participating provider contract is termed, a good faith effort of at least 30 days’ notice before effective term date is done for the members seen on a regular basis by the terming provider.

Advancing Health Equity

In order to advance best practices concerning health care, the Final Rule will soon begin to require Medicare Advantage organizations to include more substantial cultural and linguistic capabilities within their service directories. Cultural competence on behalf of health care providers is increasingly important to guaranteeing all patients accessibility to the highest quality of care. Reducing health disparities to MA enrollees will actively work to increase communication across health care and further guarantee standardization of care practices.

Improving Access to Behavioral Health

Another aspect of this Final Rule is increasing MA organizational responsibilities to provide adequate behavioral health services within network. While there are many specific new requirements, one to note will require MA organizations to establish programs of care coordination involving community, social, and behavioral health services to mirror levels of accessibility similar to acute care for all enrollees.

New additions and changes to CMS regulations are top of mind for many stakeholders within the home health care industry. At tango, our Chief Compliance Officer, Kimberly Templeton-Garcia B.S.N., CRNI, CHC , has been following the 2023 Medicare Advantage CMS 4201-F changes closely. Kim acknowledged the commitment to evaluating these changes across industry stakeholders, and regarding the Final Rule, that “at tango, we are working with our health plan and provider partners closely to monitor the full impact”.

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Q+A with Brian Lobley

tango’s Chief Executive Officer

October 2023 marks one year since Brian Lobley joined tango as our Chief Executive Officer. We sat down with Brian to reflect on his background in healthcare, his first year at tango and how he envisions the future of home care.

While this may be your first anniversary at tango, you spent almost 20 years working on the payor side of healthcare. How has the transition to tango changed your understanding of what value-based care means from a different part of the healthcare ecosystem?

Reflecting on this past year, what has been the most exciting moment or accomplishment with tango? What challenges do you anticipate as you look to next year?

What does the company name, tango, mean to you?

Looking to the future of home care, how you would like to see tango, as well as the home health care industry, innovate?

Blog:

CMS FINAL RULE 4201-F: What to Know

Ensuring Timely Access to Care

Protecting Beneficiaries

Advancing Health Equity

Improving Access to Behavioral Health

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Home Health Care News’ DISRUPT Podcast:
Interview with Brian Lobley, CEO, tango