Home-Based Care Referrals Shift to Performance Metrics Over Relationships
Health systems and payers are increasingly steering patients to home health and home care agencies based on documented performance metrics rather than traditional referral relationships, according to industry leaders speaking at a recent Home Health Care News webinar. The shift prioritizes agencies that can demonstrate quality ratings, low hospitalization rates, fast patient acceptance times, broad payer network coverage, and capacity to manage complex cases. This trend affects how Medicaid managed care organizations and health systems select post-acute care partners and may influence which home health providers maintain or lose patient volume. The change reflects broader value-based care adoption and risk-based contracting in home-based services.
Medicaid managed care plans relying on narrow home health networks must ensure contracted agencies can meet the documentation and quality standards now driving referral decisions, or risk losing members to out-of-network providers.
Long-Term Care · Managed Care
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