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Doctor Teaching on Seminar

2023 Hospital @ Home Leadership Summit Speaker Bio

Rachna Pandya Headshot

Rachna Pandya, MPH, Regional Strategic Implementation Leader, NCAL Medicare Operations & Strategy, Kaiser Permanente

Rachna leads the National Benefits, Claims and Coding efforts for Kaiser Permanente’s Advanced Care at Home initiative across the Enterprise as part of overall strategy to develop a long-term roadmap with the patient at the center. Her dual role across National and Regional strategy has led to development of benefit policy, exploration of clinical/non-clinical code sets to advocate for Advanced Care at Home with Payor lens and enhancement of Benefit operations across different lines of business in the Care at Home space. As part of her Regional Strategic leader role she helped lead the development of the 1st ever Medicare Supplemental Benefit for Advanced Care at Home effective 1/1/2022 bridging alignment across Clinical Operations and HealthPlan SME’s.

Rachna has over 20 years expertise in leading teams in transformative design, performance improvement, and development of strategic pipeline initiatives including supplemental benefits across healthplan & hospital operations for complex care populations. Her strengths are putting large complex ideas into action partnering with leadership, clinical operations, and cross functional teams with enterprise wide lens. Specialties include focus on social determinants of health with complex and vulnerable populations in partnership with SME’s across care providers, clinical operations, legal, compliance, IT, pharmacy, claims, revenue cycle and benefits administration.


The Current Payer/Health Plan Take on Advanced Care at Home

Although, early in the pandemic, large academic medical centers and health systems adopted the shift through the government's Acute Hospital Care at Home waiver, payors are increasingly leaning into strategies that cover high acuity healthcare in the home. To create long-term viability of Hospital at home, payor reimbursement continues to be one of the most pressing issues. This session will explore the evolving landscape of advanced care at home as it relates to payors and health plan coverage of Hospital at home. Healthcare leaders seeking to navigate the complexities of payor engagement and drive greater financial viability of Hospital at home, won’t want to miss this session.

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