September 29, 2022

It has long been argued that electronic visit verification (EVV) is necessary to stop fraud; now it’s also necessary for states to unlock their full share of federal funding. Under the 21st Century Cures Act, states are required to use EVV for all Medicaid-funded home health services by Jan. 1, 2023; those who don’t may not get their full federal match. To get a look at where things stand about six months out—and the benefits and pitfalls of EVV—HomeCare talked with Stephen Vaccaro, president of HHAeXchange, a company that provides homecare management software, EVV and other technology for homecare providers and payers.    

HOMECARE: It feels like we’ve not talked much about EVV in the last two years because of the pandemic. Has it been forgotten? Or is it something that’s been enhanced in some ways by the public health emergency?

VACCARO: I think what we see out in the industry is that it’s been enhanced with the pandemic because people were getting more accustomed to using technology. We’re on a video call right now, right? I think that was one reality, and then people were not in offices. And in the personal care space, a lot of what happened before [the pandemic] was paper time sheets and because the caregivers wanted to get paid on time, they didn’t want to put their time sheet in the mail and wait four days before it gets there and miss a paycheck. Before, we found a lot of them taking a bus or driving or walking to the office to manually drop off their time sheet. Then a lot of those offices were closed during the pandemic, so it created a situation where that was not working. What we started to see with different caregivers during that time period is folks were becoming more open to adopting EVV, and EVV … started to become a little bit more popular. We actually see some markets where 90% of visit confirmations come via EVV.

HOMECARE: Not delaying paychecks is a benefit I hadn’t considered. What are some of the other advantages of moving to an EVV-based system?

VACCARO: Well, there’s the initial benefit, which is a component of what the Cures act was intended to address, which is fraud, waste and abuse, right? There is a benefit to the entire ecosystem. Then we’re seeing “on-the-ground” benefits happening, such as caregivers not needing to do paper time sheets; they’re able to get their visit confirmations in real time as they’re happening. That increases the likelihood that they will be [paid] in that current pay period; there’s just no delay with their paper time sheet—with getting to the office or them not getting to the office, or a time sheet being lost, or perhaps not getting punched in correctly. All that goes away, all that noise.

EVV also allows what we see a lot of the providers offering now: different variations of quick pay, where basically, if a caregiver maybe worked on Monday and Tuesday, and for some reason they need to access the funds, they can. … It’s a great recruiting tool and it also will help the personal care industry compete with fast food, service industries and other industries that offer benefits of that nature.

And then another benefit you’re seeing is that the agencies—and potentially the family members and the payers—are able to get real-time access to what’s occurring in the home. Did the person show up? Were they late for some reason? Did they have a missed visit? If there was a missed visit, do we need to get another person in there? … You know, it’s not an option for someone not to show up today. So now (agencies) are able to intervene much more proactively than I’d say they were able to in the past. And they also have more visibility into the duties that were performed or if there are duties that are being refused.

A lot of our clients utilize our technology, specifically our mobile app technology, with their caregivers. And the caregivers really love this, that they are able to become part of the care team, which they were not really able to before; they’re in the home and they can enter observations when they get there or during their shift. Observations could be, “Hey, I arrived and nobody had shoveled the walk, so there’s an ice situation outside that would be dangerous for a slip and fall. We need to send someone here to take care of that.” Or “I came into the house and it appears there’s a food insecurity situation, or the individual’s not feeling right or responding like normal today.” That allows the care team and the provider or the payer to intervene more real-time. While the caregiver’s there they could call and say, “Hey, what are you seeing?” and maybe even do a video chat to assess if they need to do something.

HOMECARE: That seems to change the whole approach to care.

VACCARO: It really opens up a whole new dynamic around quality care and the caregiver becoming part of the care team. … Now what you really have is a valued member of the care team—that’s who the caregiver is.

HOMECARE: How does that play into the shift toward value-based care?

VACCARO: I think they go hand in hand in many ways. The federal government and different state Medicaid programs are looking to be more about paying for value, as opposed to paying for time or paying for units. I think everyone conceptually agrees with that, but it’s always been very difficult to—how do you measure that? We are starting to see a number of payers really ramping up their value-based programs. Everyone’s still figuring out the model. We have one payer—as an example—in Pennsylvania, who’s doing something very innovative where they identify specific care gaps. Think of them as key measures that increase the likelihood of outcomes. An example like that could be, did the person get their flu shot? … Or did they get their COVID vaccine, or other items of that nature; did they go for an annual physical? So they’re doing an innovative program now with their provider network, capturing this information on their recipients and then in return, rewarding their providers if they’re doing a good job with that.

We have another client, a large payer in the New York market who is doing a lot of work with us around what we refer to as our payer care insight solution, where, as I mentioned before, caregivers are able to answer questions while in the home that go back to the care team at the payer. They can determine if they see any trends coming out of that data or if they need to intervene in any manner as a way to, to increase care. So we’re seeing a number of different forms in different markets take shape. and it’s exciting. I think that we really see that as the future of where reimbursement is heading in this industry.

HOMECARE: Are you seeing any trends in how agencies are using their EVV data in terms of their own operations?

VACCARO: We’re seeing agencies put in place different types of incentive programs. It’s almost like if you go to a Starbucks and and you check in, you get your coffee and you earn rewards, right? It’s that type of thing. We are seeing agencies offering different types of reward programs or incentive programs for the caregivers to really encourage certain behaviors: making sure that they’re arriving on time for a shift, making sure that they’re doing all the duties while they’re there, making sure that they’re engaging in observations while in the home, different items of that nature. The satisfaction of the family might also weigh in—so all different metrics. That would be an example of ways that we see providers now starting to think differently.

And when you think about it, EVV really is becoming the infrastructure. That’s how we think of it. It’s kind of like the cable company came and they set up all their fiber optics to get into everybody’s house. And originally it was so you could do cable. But now you watch Netflix. Now you buy on Amazon. Now you’re playing video games against other people around the world. That’s the infrastructure that you then can build—it’s exciting. And I think it’s revolutionizing the homecare industry and really allowing it to leverage technology in ways that were never available before.