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Home Health at the Tipping Point?


Last week, information presented by experts in aging care services and home-based care achieved an unprecedented level of synergy that could bring the home health industry to a necessary tipping point toward radical redesign.

Commencing with the Pennsylvania Homecare Association (PHA) Annual Conference in Lancaster, and wrapping up at the American Academy of Home Care Medicine (part of The American Geriatrics Society annual meeting), the overarching theme was ‘changing the way aging care services are delivered.’ The proposed way to change? Deliver services via interdisciplinary teams – combinations of social and medical providers. The means to change? Collect and analyze data.

Joseph Coughlin, PH.D., Director of MIT’s AgeLab, opened the PHA conference with an overview of how the world is changing demographically, and how those seismic demographic shifts will play out. By 2047, there will be more people over age 65 in the world than there are children ages 1-5. China and Japan, in particular, will see population reductions as the older people die. China’s one child policy matures in 2020, leaving one female for every 47,000 males and a population that cannot replace itself.

Coughlin sees a future for the United States that is not medically centered, but instead is comprised of partnerships with a heavy social emphasis and a focus on education and wellness. His research at AgeLab focuses on how to meet the challenges of our growing aging society.

Lauren Taylor, a presidential scholar in public health at the Harvard Divinity School, has researched the global costs of healthcare with a focus on health instead of care. Her research has been localized to see if the findings from her book ‘The American Health Care Paradox: Why Spending More is Getting Us Less’ are replicable at the state level. Taylor’s work purports that social supports have far more to do with maintaining good health than medical interventions. Although the U.S. spends more than any other nation on healthcare, the markers for ‘good health’ are lower than most other countries. The countries whose markers are at the top for good health have a much greater social spend.

Since only four percent of Medicare expenditures are for home health, there is significant room for cost savings by reducing hospital visits and other high cost medical spends. Proving the lower costs and better outcomes possible with home health will assure that more movement is made toward home-centered care in the future.

The American Academy of Home Care Medicine conference has seen a remarkable growth in conference attendance, up 33 percent this year, and indicative of the greater interest in how home-based care will impact the healthcare delivery system.

With the emphasis on change and cost reduction across the healthcare delivery system, delivering home-centered services, which is centered on communication and partnership with medical professionals, is a very viable delivery model.

Proving that home-centered care works is getting closer to a reality as well. The implementation of electronic health records makes data collection over a broader spectrum possible. It is this data collection that is the ‘lynchpin for success’, according to Chris Van Antwerp from U.S. Medical Management. He posed some questions that will need to be answered by physicians and home health agencies:

  • How much do each of our services cost?
  • How is that cost distributed across the organization?
  • How are we performing against cost and efficiency metrics right now?
  • How are we performing against others in the market?
  • Where is there unnecessary cost?
  • How are we performing on established quality metrics right now?
  • Where are we underperforming?
  • Is there variation occurring within the organization? If so, where and why?
  • Where are our patients/clients coming from (geographically and other sites of care) and where are they going to?
  • What is the patient’s condition when we get them and when they leave us?
  • Which patients/clients do we need to be paying close attention to?

A good software partner will work with agencies to gather the right data to answer these questions and to provide assistance as changes in reimbursement and service delivery occur.

Changes in payment and reimbursement are being implemented now. Following are descriptions of the options:

  • Fee for Service is simply payment for service delivered.
  • Pay for Performance incorporates payment based on some established metrics, i.e., quality, safety, and efficiency.
  • Care Coordinated PM/PM is a per-member/per-month payment for care coordination services that are in addition to payment for medical costs.
  • Shared Savings is a payment model where a target is established and savings (or losses) against that target are shared between the payer(s) and the provider(s).
  • Bundled Payment is a single payment for a group of services defined around a clinical condition and period of time, oftentimes with different providers.
  • Capitation is a per-member/per-month fee (whole or partial) for services provided to a patient.

So, has the tipping point finally arrived for home health? It seems so. Lower cost, better outcomes, and a focus on population health management all spell CHANGE. However, you need to be ready to implement change in how your agency bills for care and gets paid. You need to pay close attention to changing models that incorporate other players into the system. You need to start creating ways to collect data that prove your agency’s care cuts down on costs and re-admission rates.

Is your agency ready?

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