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Highlights: Highmark Health

Getting health care right for seniors: HM Home & Community Services launched in 2016

A younger man talking with an older man

HM Home & Community Services was born out of the success achieved through transforming the post-acute network for a Pennsylvania health insurer’s Medicare Advantage line of business.

Post-hospital (i.e., post-acute) care is currently used by almost 42 percent of Medicare beneficiaries1. Baby boomers are aging, and the U.S. population over the age of 80 is expected to triple between 2010 and 2050, according to the 2013 UN World Population Ageing report. As hospitals and health systems are increasingly under pressure to limit the length of stays in hospitals, patients and families will need to become more educated consumers on post-hospital care. Education currently occurs during hospitalizations — often amidst immense stress and vulnerability when retention is unlikely.

Recognizing this need — and based on the success of Allegheny Health Network's Healthcare@Home service line — HM Home and Community Services LLC (HM HCS) was launched in 2016. Led by David Goldberg, HM HCS's mission is to address the importance of post-acute care (PAC) and its impact on clinical outcomes, patient experience, and overall cost of care. The vision of HM HCS is to transform PAC by removing barriers to collaboration, closing the gaps in uncoordinated care, and transforming quality, service, and value.

"Fortunately, high-quality and coordinated post-acute care models are increasingly becoming a focal point in health care. Facility-based providers, such as skilled nursing facilities (SNF), long-term acute hospitals (LTACH), inpatient rehabilitation facilities (IPR), and home health care (HHA), have a tremendous financial impact on PAC and associated government programs," explains Goldberg. "Medicare and Medicaid, and ultimately federal and state budgets, can be impacted by PAC outcomes."

"Additionally, employers — particularly those that offer retiree coverage — wrestle with the ability to continue to provide benefits to seniors, who are most in need of coordinated care after hospitalizations. It's imperative that our health care system identifies innovative solutions to solve for this less publicized — but increasingly relevant — area of health care."

HM HCS deploys a payer- and provider-agnostic network management model and acts as a solutions aggregator by optimizing the deployment of various technology partnerships and collaborations. HM HCS leverages data in order to disrupt the PAC model from a financially driven incentive model to a quality and outcomes-based incentive model. HM HCS's management model helps build higher performing PAC provider networks and supports a health plan's pay for value (P4V) contractual provisions to align incentives and drive sustainable transformation.

HM HCS is headquartered in Pittsburgh, and its customers currently include a large Pennsylvania health plan and a regional physician-owned Accountable Care Organization.

For more information visit:

1Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. Chapter 7: Medicare’s Post-Acute Care: Trends and Ways to Rationalize Payments. Washington, DC: Medicare Payment Advisory Commission; March 2015.