What is the Sembra Messenger Network?
In a “Messenger Model”, the Sembra Messenger Network acts as a neutral messenger between managed care payors and LTSS agencies, such as Family Care Homes (FCH), Adult Care Homes (ACH) and PCS Home Care Agencies (HCA).
The Sembra Messenger Network has three major valuable and important functions.
First, the network has retained the law firm of Jones Day, which is one of the largest in the world, to review managed care contracts offered to providers for non-financial and non-competitively sensitive terms, and seeks to have terms presented which are reasonable. Jones Day has reviewed many managed care provider agreements and is experienced at advising how they could be improved.
Second, the Network conducts a fee survey for the provider types in the network. There are six separate surveys, three for FCH, ACH and HCA providers who are not SembraCare customers, and three for HCA FCH and ACH providers who are SembraCare customers. You will participate in the survey that pertains to your provider type.
Through the Fee Survey the Network Manager collects confidential information via a standard form on the fees that each LTSS agency is willing to accept. This information is collated and organized so that the Manager can advise the managed care payors that x percent of the network will contract with them at a given rate, Y percent at a different rate, etc. This allows the survey’s result of the fee demands by providers to be presented to the MCO’s in a legal and proper manner.
Third, the Network serves as the communications hub through which offers to contract and acceptances flow. The MCO’s receive the fee survey summaries and determine what they will offer. Those offers, if greater than or equal to the fees that the network member was willing to provide services for are accepted by the Network manager and a binding contract is formed. If the offers are less than the fees that the Network member was willing to take, then they are conveyed to the network member, without comment. The Network member is free to respond in any fashion that is desired, including a counter offer or an offer with an explanation of the reasons for the higher demand. This information is presented to the MCO’s fully and without comment. This process continues until an agreement is reached, or the agency or the MCO in question decides not to continue to discuss terms.
Note that in this process, each LTSS agency is an independent agent, and chooses its acceptable terms on an individual basis – the Sembra Messenger process is not a joint negotiation of fees.
The Sembra Messenger Network provides objective information to the MCO payors about a PHP’s contract offer, such as comparison data and definition of terms. The messenger makes no recommendation, and LTSS Agencies in the network are prohibited from communicating recommendations to each other. The messenger never participates, inspires, leads, recommends or influences acceptance, refusal or modification of financial terms.
One major advantage of Sembra’s Messenger Model is a single-point communications conduit for PHP’s and LTSS Agencies. By aligning with Sembra Messenger, our LTSS agencies benefit from SembraCare’s standing in the community and reputation along with some of the best legal representation in the country. By working with Sembra Messenger, PHP’s are able to communicate with many LTSS agencies through a single, familiar conduit.
Can I join Sembra Messenger Network?
Yes, any Family Care Home, Adult Care Home or PCS Home Care Agency – even non clients of SembraCare – can join our Messenger Network.