Home-Based Care Providers Must Balance Rising Payer Demands With Discipline

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Home-based care leaders at Home Health Care News’ FUTURE conference said payers and referral partners are pressing providers for faster referral responses, quicker starts of care and more detailed performance data. They also urged providers to build compliance into daily work, choose partnerships that fit their capabilities and use technology carefully to create capacity.

Home-based care leaders say payers and referral partners are setting tighter expectations for referral response times, starts of care and performance data, pushing providers to improve operations while remaining selective about the relationships they pursue. Speakers at Home Health Care News’ FUTURE conference said providers also need clinical expertise, reliable compliance practices and technology that adds capacity without pulling them beyond their strengths.

Dean Alverson, CEO of LifeCare Home Health Family, said payers and health systems selecting preferred providers increasingly expect agencies to accept referrals within seven to 10 minutes and begin care the same day or within 24 hours. He said partners also look for the clinical disciplines and expertise needed to serve their patient populations. “If you don’t have all the disciplines, you’re going to get left out,” Alverson said.

Alverson said partners want granular performance data, including information on rehospitalizations linked to medication errors or gaps in care. Providers without useful data may risk losing a place in payer networks, he said. Jamie Davis, owner of durable medical equipment supplier Cornerstone Medical Supply, argued that compliance should be part of daily operations rather than a periodic exercise. “A lot of people have their compliance week, they’ll have their compliance day, but it’s not embedded in the business,” Davis said.

Speakers also cautioned against pursuing every contract or expansion opportunity. Aaron Marcum, co-founder of Riverside Home Care, said organizations should avoid moving too far outside their operational strengths, including when considering mergers, acquisitions or new locations. Riverside focuses on private-pay and Veterans Affairs-related work, as well as personal care and related services in Colorado and Wyoming.

Meeting Expectations Without Overreach

The demands described by the speakers link referral access to operational speed, clinical breadth and the ability to show results. For providers, failing to respond quickly or supply the data partners request could weaken their position when payers and health systems select preferred agencies. At the same time, taking on services or populations beyond a provider’s capabilities can strain staffing, clinical quality and compliance.

That balance has practical consequences for patients and workers. Faster starts may help patients receive care sooner, while stronger data can help partners evaluate service performance. But these goals depend on adequate staffing, sound processes and technology that works in practice. Alverson said LifeCare pays home health staff per visit and argued that efficiency gains should be shared with employees as well as used to increase capacity.

Technology and Capacity Plans

LifeCare is using AI-enabled scribe technology to shorten documentation time during start-of-care visits. Alverson said the company reduced the time for a start of care from about two and a half hours to about 45 minutes. He said the saved time can be reinvested in patient interaction and could allow clinicians to complete four or five starts a day rather than three. Those are Alverson’s descriptions of the company’s results and potential capacity, not independently verified sector-wide outcomes.

Adding capacity also requires coordination beyond the clinical visit. Alverson said LifeCare has asked sales teams to generate enough referrals to make use of the time clinicians gain. He would prefer AI tools integrated into the company’s electronic medical record (EMR), while saying LifeCare has kept flexibility in its third-party technology contracts so it can change solutions as better options become available.

Marcum advised providers to check what their existing EMR can already do, and what its vendor plans to add in the next three to six months, before buying separate AI products. Davis said human subject-matter expertise remains necessary to assess AI-related compliance and risk. The comments reflect different parts of the same operating challenge: technology may support faster work, but it does not replace clinical judgment or oversight.

““You’re going to have to get granular.””

— Dean Alverson, CEO of LifeCare Home Health Family

Limits of the Reported Gains

The conference comments do not establish how widely the reported payer timelines apply across markets or contract types. The speakers did not provide a broader dataset showing how many payers use the seven-to-10-minute referral response expectation, or how often agencies lose preferred status for missing data or speed targets.

LifeCare’s reported documentation-time reduction and possible increase in daily starts were presented by Alverson; the report does not provide independent validation, implementation costs, or details on how the results vary by clinician or patient. It is also unclear how quickly EMR vendors will deliver the more integrated, AI-oriented systems Alverson anticipates, or how providers will measure the effects on patient outcomes and reimbursement.

Provider Decisions Ahead

Providers will need to assess which payer and referral relationships match their service capabilities, then review whether staffing, clinical coverage, data systems and compliance processes can support the stated expectations. The speakers’ advice also points to near-term technology checks: examine existing EMR functions and vendor road maps before committing to additional tools, and retain qualified human review of AI-related risks.

No specific policy change, payer deadline or new industry standard was announced at the conference. The next developments to watch are whether payer expectations become more uniform, how EMR vendors incorporate AI tools, and whether agencies can document improvements in response times, capacity and patient service.

Key Questions

What are payers and referral partners asking home-based care providers to do?

According to LifeCare CEO Dean Alverson, some partners increasingly expect referral responses within seven to 10 minutes, care to begin the same day or within 24 hours, and evidence that providers have the relevant clinical expertise and performance data.

What data did the conference speakers say partners want?

Alverson cited detailed information such as how many patients are rehospitalized because of medication errors or gaps in care. The report does not specify a common data format or a universal reporting requirement.

How did LifeCare use AI scribe technology?

Alverson said scribe technology reduced LifeCare’s start-of-care time from about two and a half hours to about 45 minutes. He said the company aims to use some saved time for patient interaction and added capacity; the report provides no independent verification of those figures.

What did speakers advise before buying new AI tools?

Marcum recommended checking existing EMR features and the vendor’s plans for the next three to six months. Davis also stressed the need for subject-matter experts to review AI compliance and risk.

Why should providers be selective about payer relationships and expansion?

Marcum said providers should avoid moving beyond their operational strengths. Selectivity can help organizations match their services and expertise to the patients and contracts they can support.

Source: rss