Our Mission

We aim to unite leading providers and stakeholders to advocate for value-based payment models that recognize high-quality care at home. We are committed to integrating Medicare and Medicaid to be able to bring the benefits of value-based payment models to dually eligible individuals in their homes and communities.

Please reach out to us if you are interested in learning more about ways your organization can get involved in support of our mission to distinguish high-value care at home.

Aligning Medicaid Benefits with the Medicare Services they Impact

State and federal governments must strive to transform contracts between Managed Long-term Services and Supports (MLTSS) plans and their downstream providers into risk-sharing arrangements that promote service delivery accountability. The Coalition for Excellence explores opportunities to more effectively capture savings from the high-quality, preventive, and supportive services offered through the Medicaid program. These savings, when delivered in unaligned arrangements with Medicare, are unable to be reinvested into the Medicaid homecare delivery system and workforce. State and federal governments are encouraged to improve Medicare-Medicaid aligned arrangements to allow for risk contracting within the delivery of services for dually eligible populations.

Developing Value-based Payment Arrangements for Organizations Serving Dually Eligible Individuals

When Medicaid services are paid for in separate health plan arrangements from Medicare, the savings generated from State Medicaid program-funded services are ‘lost’ to unaligned entities that cover Medicare, either Medicare Advantage Plans or the Federal Government. This is because Medicaid services are typically preventive and supportive in nature, such as daily home health aide visits and durable medical equipment benefits, which in turn avoid corrective medical and acute treatment actions that Medicare pays for such as emergency room visits and hospitalizations. When Medicaid is aligned with Medicare, Medicaid providers can benefit from their actions that avoid unnecessary and preventable Medicare activities, which are often expensive.

Embracing Technology

There is a need for more technology in the home setting, including personal devices such as smartphones and laptops, that can enable caregivers to be more actively engaged in information exchange as part of the care team. The Coalition for Excellence believes in reinvesting Medicare shared savings into technologies that will allow homebound individuals and their Medicaid-funded caregivers to better access their care teams and inform their person-centered care plan.

Guiding Principles

Through partnership with the leading homecare agencies in the state, the VBC at Home Coalition’s mission is to address the many challenges in homecare, guided by these principles.

  • Nationally, 75% of Long-Term Services and Supports (LTSS) users are beneficiaries dually eligible for both Medicare and Medicaid. In New York State, this figure rises to 90% of LTSS recipients. This population often encounters fragmented care and suboptimal health outcomes due to inadequate coordination between the two programs. The Homecare Coalition is committed to advocating for new state and federal funding opportunities that support initiatives aimed at more effectively integrating home- and community-based services (HCBS) into the broader healthcare system.

  • Although managed long-term care (MLTC) plans receive state capitated payments, they often treat homecare as a commodity, compensating agencies on a fee-for-service (FFS) basis and failing to recognize their potential to add value. By developing value-based payment arrangements, payments between plans and homecare agencies have significant potential to improve quality and drive accountability.

  • A rigid regulatory framework for homecare at both state and federal levels restricts flexibility in collaboratively sourcing innovative service delivery ideas. Consequently, the homecare sector lags behind others in adopting new technologies that could enhance patient care by integrating HCBS into the care continuum. It is essential to further explore opportunities that promote information sharing between acute and long-term care stakeholders.