Portfolio Insights – tango

Issue 12, May 2024

The Leverage Health Portfolio Insights Series

In our ongoing commitment to advancing transformative solutions and pioneering advancements in healthcare, Leverage Health proudly presents the second installment of the Leverage Health Portfolio Insights Series. As the industry’s leading Venture Catalyst, we are dedicated to illuminating the trailblazers who are shaping the future of healthcare.

Throughout this exclusive series of interviews, we have the privilege of diving into the minds of visionaries who are driving change, disrupting norms, and championing progress within our dynamic portfolio. From revolutionary technologies to groundbreaking care delivery models, each conversation offers a unique insight into the strategies, experiences, and visions of leaders at the forefront of healthcare innovation.

Join us as we uncover the stories behind the solutions that are redefining the healthcare landscape, one breakthrough at a time. Welcome to the Leverage Health Portfolio Insights Series – where inspiration meets impact, and where the future of healthcare begins.

Richard Lungen (Leverage Health)

Welcome Brian and thanks for joining us today. When did you become CEO of tango and can you explain the process since you became CEO to now leading the company?

Brian Lobley (tangocare.com)

I became CEO of tango in October of 2022 after a long career in managed care with Independence Blue Cross as a Chief Operating Officer at IBC.  At Independence, one of my favorite roles was overseeing the Medicare Advantage business line.  I am passionate about the care and benefits provided to seniors and vulnerable populations and am proud of the work that we did during my tenure, building a 5-Star plan with strong product offerings, excellent networks, and service for our members.

When I first learned about the work tango, (then PHCN), is doing to solve post-acute care challenges, especially for the Medicare Advantage population, I jumped at the opportunity to transform the way post-acute care, primarily home health care, is provided today.  What many carriers, including myself during my time at Independence, often don’t realize is that while access to home health is constrained for all Medicare beneficiaries (as the home health industry struggles with staffing shortages and lack of skilled resources, even more so after COVID), reimbursement dynamics further exacerbate access challenges for Medicare Advantage members.  As a former payer, we paid claims for services provided, but never saw claims for services not rendered.  Today, many Medicare Advantage members are getting referrals from their providers for skilled home health services, but those referrals are going unfulfilled, and that’s a significant issue for the industry when we think about honoring member preferences to recover at home, and providing care that can optimize their recovery, increase their functionality, and drive improved health outcomes, at a lower cost, especially following an acute event.

This is the heart of the problem tango is really trying to solve: how can we enable activation of the home as a preferred site of care, while enabling home health care providers to expand access and do what they do well, which is to help patients recover at home while in a fragile and vulnerable state?

At tango, we believe a value-based home health care model is key to enabling access, better care, and improved outcomes for members.  The work we’ve done over the past year is focused on building market-leading networks of the highest quality home health providers across the country who are rewarded for the outcomes they deliver to our members.  Our clients are typically payers, and we work with them to service their members, ensuring home health care referrals are placed in a timely manner with our preferred high-quality network providers, and that the savings we generate are shared with payer, as well as the provider.  Today we service a large portion of the Mountain-West but are expanding nationally and excited about the opportunity this brings to better meet the needs of members in these new regions.

Richard Lungen

Thank you, what is the gap in health care or the problem that tango solves beyond what we just talked about? As you think about post-acute home care, how is tango going to make a difference in that sector?

Brian Lobley 

As we just discussed, I think the first issue is access, in particular, timely access to home health care, and the second issue is sub-optimal outcomes as a result of access being limited.  It goes without saying both issues have an impact on the care we are providing and the service that we as an industry are providing to Medicare beneficiaries, which frankly we have an obligation and fiduciary duty to do a better job providing care to this vulnerable population.

To break down the problem down a bit more: today, when someone is ready to be discharged from an institutional setting, there needs to be an established pathway that quickly places the member with a quality home health care provider, and ensures care is initiated on a timely basis.  Placement and timely initiation of care are paramount to ensuring a successful recovery at home and avoiding unnecessary re-admissions and ED utilization.

Placing Medicare Advantage home health referrals can be challenging for a few reasons – the first being that there is a skilled labor shortage in home health. The second is that traditional Medicare typically pays home health agencies more than Medicare Advantage and tends to be less of an administrative burden.

This problem impacts multiple stakeholders:

First and foremost, patients and caregivers.  Our inability to honor and allow members to recover at home is a failing of the industry.  Put simply, we must do better at allowing members to receive care in the home, and provide better support to caregivers, so that home recoveries are successful and not laden with stress and worry.

Hospitals and skilled nursing facilities are struggling to discharge members in a timely manner without a defined plan and clear understanding of when home health care services can be initiated.  Delays in finalizing the discharge plan may also increase LOS, without additional payment, as these institutions are often receiving a case-rate (DRG’s) payment for their services.

Home health agencies need payment innovation that rewards them for the care of Medicare Advantage members.  Without appropriate incentive and recognition for the high-quality care they are providing, Medicare Advantage referrals run the risk of not being placed or being placed on a delayed basis.  Our data has shown that when tango is supporting home health referral placement, we can improve member placement with a home health care provider by at least two days, which is critical as it is well published that the period immediately following discharge from an acute or post-acute stay is when the member is most likely to be re-admitted or return to the ED.

And finally, Payers need solutions that will not only improve the health and outcomes of their members, but honor the preferences of their members, ensuring they have the best experience possible.  This is critical for Stars Ratings, as well as improvements in total cost of care.

tango’s solution addresses these challenges:

• We have a solid network of high-quality providers and partnerships with home health agencies who are ready to work with tango to activate home health care for the members we service.  Our network is also curated by specialty, to better match patients and their needs.
• We also have an innovative payment model that ensures these agencies will provide timely care to our members and are rewarded for the outcomes they deliver.
• Finally, we have a proven model that shows when a member is placed in a timely manner and receives access to home health care, we can reduce readmissions and inappropriate ED utilization dramatically.

Richard Lungen

When you think about the market, what is tango’s unique differentiator?

Brian Lobley

Our process is unique in that it begins during discharge planning. Most of the post-acute benefit management services begin post-discharge, when an authorization is present, and a claim is ready to be paid. In other words, the home health care visit has already been placed, granted, and maybe even initiated.

tango starts ahead of that. Our recent partnership with WellSky is really exciting, because we now are able to get information on discharge planning as much as two to three days ahead of discharge.   This is really key to influencing site of care decisions, as well as timely placement with one of our high-quality home health care providers.

Our partnerships allows us to see data in Careport so as the discharge plan is coming together, we can have anticipatory conversations with our providers to place the member – – we take the referral, ensure the information is complete and ready to be handed to a home health care provider (which is a huge benefit for our home health agencies who do not have to spend administrative dollars chasing referral information), and we place the member with a high quality provider, offering us the best start of care timeline.

Our process is nimble and we can create a personal match for the patient – for example, if they have a preferred agency, or one that may be a better fit for their needs, such as specializing in wound care.

This is really important, because the needs of a 65-year-old patient who is healthy, but just had a hip replacement, are going to be a lot different than an 88-year-old poly chronic patient getting discharged following a major surgery who may need wound care or other rehabilitative services to support their recovery.

By starting upfront in the process, we’re able to steer to our highest quality and best skilled providers.  That doesn’t happen if the referral is already placed.

Our services also go a step further – we enable the provider to be successful in their value-based arrangements with tango and support them in providing comprehensive care to our members during the home health care episode.  Because we know our providers are short staffed and often rushing to get to their next visit, we have created a care enablement team that supports our providers and helps them with member risk scoring throughout the home health episode. Additionally, they can address secondary needs identified during the home health visit, such as scheduling follow-up appointments, ensuring DME supplies are in the home to continue care, or helping to activate benefits that address social determinants of health.

Richard Lungen

What is ahead for tango for the rest of 2024 and beyond?

Brian Lobley

What’s the vision? Our strategy is focused on growth. We are focused on getting high-quality payer partners and continuing to build superior network of home health care providers.  For payers, a lot of our discussions are focused on education to help them better understand the implications that limited access to home health care is having on their members, health outcomes, and ultimately total cost of care.

As it relates to payer growth, our strategy has been to land and expand. We like to get into a state, build a strong network, and then expand with as many payers as we can in those states.

And as it relates to our provider partners, well they love our solution.  They are excited about finding new pathways that will finally reward them for the great care they are providing to Medicare Advantage members. They also appreciate that we are not getting in the way of care, but rather enabling it. We’ve taken that on in a very direct way – we are not a convener, and our services go beyond Utilization Management.  We’re focused on home health care enablement and trying to enable the delivery of home health care so that all stakeholders win, especially, the member.