Pennsylvania health insurer Independence Blue Cross (IBX) has partnered with post-acute benefit enablement company tango to expand access to home health care through value-based reimbursement arrangements.

The partnership, announced on Tuesday, is designed to lower readmission rates and total cost of care by building IBX’s home health network for its Medicare Advantage members.

“Our whole model is to drive timely home health access, because we believe that reduces the total cost of care in a post-acute setting,” Brian Lobley, CEO of tango, told Home Health Care News. “Our objective really is at discharge, to get someone who’s qualified for [skilled home health into their homes] as fast as possible. We believe that we shorten that duration.”

Phoenix, Arizona-based tango is a managed service organization that partners with health plans to enable post-acute care for Medicare Advantage and Medicaid dual enrollees. The company provides utilization management services and aims to take full risk with its reimbursement agreements, Lobley said.

The partnership, launched in May, has been in a transitional period, Lobley said, in which the company works with hospitals and providers to inform referral parties and home health agencies that tango will act as the payment mechanism, managing referrals and fielding claims.

“It takes 60 to 90 days, about a quarter, to get the model in,” Lobley said. “We do a ton of education beforehand, start 60 days before go live, but then we are doing a lot of retraining throughout first and second quarter so we can get the model where it’s pretty seamless and working directly with tango.”

Early data from the program found 100% of qualified referrals for IBX Medicare Advantage members were placed with a home health agency within two days of tango receiving the referral, with a 97% member satisfaction rate, according to the company.

When working with home health agencies, tango pays providers a set rate, measures the readmission and emergency room rates in the post-acute setting and shares some of the savings from lower readmission rates.

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tango, a provider of post-acute care benefit enablement services, has entered the Pennsylvania market through a partnership with AmeriHealth Caritas, a national provider of Medicaid managed care.

This collaboration allows tango to support the delivery of skilled home health care to Medicare Advantage (MA) dual-eligible special needs plan (D-SNP) members in Pennsylvania. The partnership marks a major advancement in improving post-acute care for dual-eligible members in Pennsylvania, according to the company.

“By combining tango’s data-driven, fully delegated home health platform with AmeriHealth’s local expertise and commitment to value-based care, we’re able to create a more seamless, coordinated experience for patients transitioning from an acute or post-acute episode to home,” tango CEO Brian Lobley told Home Health Care News. “This collaboration enables timely and appropriate referral placements, reduces avoidable readmissions and leverages real-time in-home data to support proactive care management tailored to the needs of Pennsylvania’s dual-eligible population.”

Based in Phoenix, tango offers value-based care enablement platforms for payers, risk-bearing organizations and providers to collaborate more effectively in serving MA, managed Medicaid and dual-eligible populations.

AmeriHealth Caritas, based in Newton Square, Pennsylvania, operates in 13 states and the District of Columbia, offering Medicaid, Medicare, Children’s Health Insurance Program (CHIP) and Health Insurance Marketplace coverage through managed care, pharmaceutical benefit management, specialty pharmacy and behavioral health services.

Several key challenges emerge when transitioning patients to home-based care, according to Lobley. One major challenge is the ongoing shortage of nurses and caregivers, which can limit provider capacity, especially in underserved areas. Even when patients are clinically suitable for home-based care, a lack of available staff can delay or prevent care from starting on time.

Referral placement presents another challenge, Lobley said. Making sure that patients are paired with the appropriate home health provider is crucial. Delays in this step can cause slower care initiation and missed chances for early intervention. This is particularly vital after a hospital or facility stay, when prompt follow-up is needed to keep patients stable at home.

“Our platform addresses these challenges by enabling real-time, upstream referral management integrated directly into acute family electronic medical records, helping to ensure timely and appropriate placements, even in harder-to-serve areas,” Lobley said. “Our network model also supports more timely starts of care, which is key to helping members achieve better outcomes post-discharge. In parallel, our dedicated care model and value-based provider network help alleviate administrative burdens and focus clinical resources where they’re needed most.”

This coordinated approach improves readmission rates and helps cut unnecessary emergency visits, leading to better outcomes and lower total care costs, he noted.

The platform improves coordination among payers, providers and risk-bearing entities by serving as an integrated infrastructure that combines technology, data, clinical services and network operations across the post-acute ecosystem, according to Lobley.

“Our vision for the future of post-acute care within Medicaid-managed care is to expand our impact across the entire post-acute continuum, while maintaining a focus on enabling recovery and continuous care at home,” Lobley said.

Lobley said the company is exploring new solutions and partnerships aimed at creating a more integrated experience that supports seamless transitions and higher-quality in-home care. The company is also investing in enhanced analytics.

“Given the vulnerability of the Medicaid population, our focus is on creating solutions that not only improve care delivery but also allow us to intervene earlier and more effectively,” Lobley said.

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