'We think it's a game changer'

Friday, July 31, 2009

HARTFORD, Conn.--CareCentrix has worked quietly over the past 10 months, formulating a new strategic plan that ties in directly to healthcare reform. During that time, the benefits-management company - HME, home care and infusion - for private insurers has put in place a new executive team of healthcare professionals. Its mission: Prove that homecare services can “reduce a payer’s inpatient costs while delivering improved and clearly measurable healthcare costs.” CareCentrix, which generated $315 million in revenue last year, provides these services through a network of HME and other homecare providers. CEO Eric Reimer recently discussed the company’s focus on outcomes with HME News.

HME News: Give a brief rundown of what you are doing to reduce inpatient visits.

Eric Reimer: We’re looking at how we can identify people who are at high risk for readmission. Then we’ll do things like a pre-discharge visit. We’ll send a nurse into the hospital before the discharge so they can tell the patient this is what you can expect at home. They also tell the caregiver that these are the kinds of things that you need to be prepared for when you get to home. They’ll tell them, “These are the things you should go back to the hospital for. But these are the things that are manageable at home; call us and we can help you avoid going back into the ER.”

HME: So you focus a lot on education.

Reimer: Absolutely.

HME: If I’m a payer, that sounds appealing.

Reimer: We think it’s a game changer. The reality is that home health visits are $125 each, and an inpatient stay is $2,500 a day. It may be the case that home health costs should go up as you reduce inpatient costs along with it. Our view is that the ultimate opportunity is to substitute home days for what used to be bed days, where appropriate.

HME: Can you charge a higher fee for this service?

Reimer: It’s less about higher fees. We are trying to align the incentives so that we get part of the value that we create. We might say, “Lets split the savings 80/20. You keep 80% and we keep 20% if we are able to  bring the savings to a certain level.”

HME: Do you think ultimately all payers, including Medicare, will look at outcomes and readmission rates to help decide what providers they choose to work with?

Reimer: I think it’s just a matter of time. That is where the industry is headed. The best providers are going to get ahead of the curve and prove that they lower readmission rates.