Highmark ends contracts with 10 nursing facilities, eight home care agencies
January 11, 2016 12:00 AM
Roselle Tena with Renaissance Home Care Inc. in the lobby of its Mt. Lebanon office.
By Steve Twedt / Pittsburgh Post-Gazette
Highmark is streamlining its rehab and home health offerings, pushing 10 skilled nursing facilities and eight home health agencies out of its commercial and Medicare Advantage networks for 2016. Traditional Medicare fee-for-service is not affected.
While the non-renewals represent a small fraction of Highmark’s remaining skilled nursing and home health options for its members, the move signals a change in how the region’s dominant insurer manages that part of its business, said Robert Wanovich, Highmark’s vice president of market strategy. Typically, Highmark has terminated only one or two agencies each year, he said, and Highmark members still have access to “the vast majority” of the nearly 200 skilled nursing facilities in western Pennsylvania.
“This is actually an example of Highmark beginning to act differently, as really an integrated health care and financing system,” adding that the changes are part of a statewide action.
In years past, Highmark “really didn’t focus on post-acute care,” Mr. Wanovich continued, referring to that period when members leave the hospital for rehabilitation requiring skilled nursing or return home still in need of some help or care.
Skilled nursing facilities no longer in Highmark’s network:
Golden Living Center, Mt. Lebanon; Meadowcrest Nursing Center, Bethel Park; Heartland Health Care Center, Shadyside; Southwestern Nursing Care Center, West Mifflin; Autumn Grove Care Center, Harrisville, Butler County; Greenery Specialty Care Center of Canonsburg; Consulate Health of North Strabane; Latrobe Health and Rehabilitation Center; Transitions Healthcare North Huntingdon; and Edison Manor Nursing and Rehab, New Castle, Lawrence County.
Home health agencies no longer part of Highmark’s network:
Renaissance Home Care, Inc., Mt. Lebanon; Visiting Nurse Association of Erie County; Titusville Area Hospital Home Health Agency; Abby Health Care, Inc. of Uniontown, Fayette County; Harmarville Home Health Agency; Nightingale Home Healthcare of Western Pennsylvania, Inc., Monroeville; Superior Home Health and Staffing, Inc. McKeesport; and The Ambassadors Company, LLC, Dormont.
“We learned that it was very important for hospitals and doctors to have insight into the quality of care and readmission rates that are coming from these types of services” so they can identify the facilities that Highmark believes offer access to the best quality services at an affordable price.
The excluded facilities and agencies extend from Erie to Fayette County and include businesses that have been part of Highmark’s network for decades.
“I’ve probably been 30 years with Highmark,” said Connie Slampak, administrator for Abby Home Health Services in Uniontown, Fayette County, one of the health agencies dropped.
She said Highmark first notified Abby last fall that their reimbursement payments would be reduced by 21 percent. “I believe they were hoping I would not sign the contract.” But she did sign, only to get another notice in December that Highmark was terminating the contract.
“This was totally unforeseen,” she said. “To have my contract cut for no reason is kind of demeaning.”
Renaissance Home Care, Inc. in Mt. Lebanon is another health care agency dropped by Highmark.
Administrator Roselle Tena said she anticipated the change a few years ago and expanded the business to include home care maintenance services, which are not typically covered by insurance. Between that and her contracts with other insurers, the business is intact although losing Highmark “is an extreme impact,” she said. She suspects her client list of nearly 100 wasn’t enough volume for Highmark, despite the agency’s high patient satisfaction marks.
“It’s showing the way that home care is moving with this value-based purchasing,” she said. “The problem I have is I don’t know how the really frail, the really vulnerable, are going to access care.”
Mr. Wanovich said Highmark now has access to more detailed information about post-hospital care to help them assess and manage their network. In addition to the extensive data gleaned from its own members’ experiences, the Centers for Medicare and Medicaid Services has launched two websites for consumers: www.medicare.gov/nursinghomecompare/search.html, which rates nursing homes and www.medicare.gov/homehealthcompare/search.html, which rates home health agencies.
“We have better information, better insight,” he said.
What has frustrated the operators is the lack of explanation for being removed from the Highmark network.
Gregory Tinz, campus executive director at Southwestern Nursing Care Center in West Mifflin, noted that his facility has received an above average rating from Medicare and it has a long-standing relationship with nearby Jefferson Hospital, part of the Allegheny Health Network that is part of Highmark Health.
“We’ve worked hard to reach that four-star rating and then, here you go, we’re tossed out. It’s kind of mind boggling to me.” Now, he said, if residents in Southwestern’s long-term facility need to go to the hospital, they may not be able to return to the skilled nursing area after discharge. “When residents who have been here five years, 10 years, have to go to a different place, it upsets them. It confuses them.”
Any change can be difficult, especially for seniors. Naomi Crapp, 93, of Filbert, Fayette County has relied on Abby Health Care staff often since her stroke more than 10 years ago. With Highmark dropping Abby, “They took away the Abby nurses and they’re the ones who saved me many times. I love every one of them,” she said in a recent phone interview. After switching to Aetna, she’s hoping she can still see those nurses.
“Disruption is certainly not something we take lightly,” said Mr. Wanovich, “but at the same time, our members expect us to provide them with quality, affordable services, so that is the balance we’re always attempting to strike.
“We believe this is being done in the best interest of our members.”
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