Open post
tango and WellSky

tango and WellSky® Partner to Revolutionize Post-Acute Care Benefit Management With End-to-End Program to Manage Care and Outcomes

tango and WellSky® Partner to Revolutionize Post-Acute Care Benefit Management With End-to-End Program to Manage Care and Outcomes

Business Wire | February 29, 2024

tango and WellSky

With this first-of-its-kind collaboration, health plans will be better enabled to drive improved outcomes and patient and provider experience through a next generation value-based program across acute, post-acute, and home settings.

OVERLAND PARK, Kan., and PHOENIX, Ariz. — February 29, 2024 — Today, leading healthcare technology and services firms tango and WellSky announced they have partnered to deliver a fully integrated, post-acute care (PAC) episode management program for health plans, focused on facilitating high quality, end-to-end post-acute care management. This innovative partnership is intended to align incentives for health plans, risk bearing entities, providers, and patients across the post-acute continuum. Together, tango and WellSky aim to enable higher quality care, enhance provider experience, reward providers for quality outcomes, boost patient satisfaction, and deliver guaranteed cost savings.

The partnership combines tango’s market-leading, value-based home health enablement platform and networks with WellSky’s industry-leading acute and post-acute technology, analytics, and services. Together, the partnership will address key marketplace challenges, such as limited or delayed access to optimized transitions within post-acute care, disjointed incentives, lack of effective integration and connectivity, and reimbursement issues.

“By joining forces, tango and WellSky are at the forefront of revolutionizing post-acute care enablement,” said Andy Eilert, president of payer and emerging markets at WellSky. “With the seamless integration of powerful technology, rich data, and advanced services capabilities, our collaboration provides the opportunity to optimize the patient's journey. This program facilitates effective and timely access to appropriate and high-quality post-acute services for each patient, resulting in a ‘win-win-win’ impact for patients, providers, and health plans.”

The partnership provides a modern solution for health plans and risk-bearing entities to improve medical outcomes and reduce the total cost of care by enabling care and coordination across home health, skilled nursing, inpatient rehabilitation, and long-term acute care facilities in a unified model. This program allows health plans to take a holistic approach as opposed to managing services separately, which many health plans do today. Additionally, it enables providers to be aligned and incentivized appropriately for achieving superior clinical and total cost of care outcomes.

“Optimizing post-acute care tailored to patients' conditions and preferences is paramount. Our decades of experience in home health and curated value-based networks enable us to confidently help ensure patients get the quality care they need, when and where they want it. The tango and WellSky partnership positively impacts the patient and provider experience through our ability to transition a member seamlessly and quickly from acute and post-acute facilities to home," explains Brian Lobley, tango CEO.

This collaboration can facilitate significant financial benefits for health plans through a delegated model coordinating and managing the PAC episode with guaranteed cost savings and shared savings. This partnership simplifies outsourcing for health plans, as the risk and management are maintained under one partnership.


Read Original Article

Open post
Disrupt Home Health Care

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

Value-Based Care

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

By Joyce Famakinwa | February 7, 2024

Disrupt Home Health Caretango 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.

Subscribe to Disrupt to be notified when new episodes are released. Listen today on Apple Podcasts or SoundCloud.

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.


Read Original Article >

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

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

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

By Joyce Famakinwa | December 4, 2023

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.


Read Original Article

Open post
How it works. A patient’s doctor orders medical services.

The Vistria Group Announces Majority Investment in Professional Health Care Network (PHCN)

The Vistria Group Announces Majority Investment in Professional Health Care Network (PHCN)

PHCN becomes newest investment in firm’s push to enhance access to and elevate the value of home health care

Chicago, IL, March 30, 2022
The Vistria Group today announced its investment in Professional Health Care Network (PHCN), a home health care management services company that partners with health plans and providers to increase the access and value of home-based clinical care. The transaction with PHCN represents the fifth investment from Vistria Fund IV, a $2.68 billion fund.

The Phoenix-based company is a leading provider of home health management solutions and care coordination throughout the western U.S. Working in collaboration with major health plans and providers, PHCN has demonstrated a proven track record of providing greater access to home health care in the recovery stages, effectively reducing emergent and long-term institutionalization, and above all, improving the satisfaction and health outcomes of PHCN’s over 950,000 patients.

“From selection of the agencies within our network to the timeliness of in-home provider placements, our organization is intentional in everything we do to ensure alignment among payers, providers and patients. As a result, our solutions have lowered readmissions, reduced administrative and care costs and produced a 98% patient satisfaction rate,” says Brian Sassi, CEO of Professional Health Care Network. “Our partnership with The Vistria Group will help us expand those collaborative efforts and continue to provide unique solutions that increase access and quality of home health services and drive success in our next chapter of growth.”

In recent years, the healthcare industry has experienced a significant shift towards value-based care and home-based care delivery, further catalyzed by the effects of the COVID-19 pandemic. Within these sectors, The Vistria Group has understood these opportunities and has been a dedicated investor in both care provision and technology solutions across the home health, home & community-based services (HCBS) and advanced illness sectors.

“Since our founding, The Vistria Group has had a long-standing commitment to driving innovation and increasing access to high-quality, value-based healthcare that’s showcased through our portfolio companies,” says David Schuppan, Senior Partner and Co-Head of Healthcare at The Vistria Group. “The investment in PHCN was a strategic, three-fold decision, geared around increasing access to home health services, in addition to accelerating the shift towards value-based care and creating the premier network of home health providers.”

“We believe in the importance of timely and high-quality home health to ensure patients are able to both transition and recover effectively within their homes. Our home health provider partners are critical to the delivery of positive clinical outcomes and the prevention of unnecessary hospitalizations. PHCN is the innovative platform that enables the most effective collaboration between payors, risk bearing entities and home health providers and is leading an accelerated shift to payment models that directly align to superior clinical outcomes and value,” says Brandon Cady, Senior Operating Partner at The Vistria Group. “We are excited to partner with the PHCN leadership team to support the continued growth of this important asset.”.

“Over the course of the pandemic, the need for home health drastically increased and as a result, forced the industry to get innovative, an area that The Vistria Group had already been equipped to serve,” says Nick Loporcaro, Senior Operating Partner at The Vistria Group. “It’s exciting to have the opportunity to enhance the care coordination system through our partnership with PHCN, providing a better network for payors and providers and ultimately, better health outcomes for patients.

MTS acted as financial advisor to PHCN on the transaction. Triple Tree acted as financial advisor and Ropes & Gray LLP acted as legal counsel to The Vistria Group on the transaction.