AHHQI Releases Report on Optimizing Home Health Value

ARLINGTON, Va. (October 20, 2016)—The final report from the Alliance for Home Health Quality and Innovation (AHHQI)’s Future of Home Health Project was published online this month in the peer-reviewed journal Home Health Care Management and Practice. The article, “The Future of Home Health Care: A Strategic Framework for Optimizing Value,” outlines a vision for the role and relevance of home health and home-based care and recommends a framework for the Medicare-certified home health agency of the future.

Critical to the strategic framework for the future are three key roles that the home health agency of the future will play. The authors state that home health agencies will play critical roles in: 1. providing post-acute care and acute care at home; 2. partnering with primary care; 3. partnering with home and community-based long-term care programs. In these roles, home health agencies will provide time-limited rapid escalation of skilled nursing, therapy and other support to enable patients to avoid hospitalization and to be integrated into community life.

“By designing a strategic framework for the future of home health care delivery, we hope to enhance the ability of home health agencies to provide high quality care to ensure patients improve or remain as healthy as possible,” said Steven Landers, MD, President and CEO of VNA Health Group and Vice-Chairman of the Alliance Board of Directors. “The report provides direction on how new and alternative models should be structured to ensure home health agencies can participate in, and add value to, new payment structures designed to decrease spending by reducing hospitalizations and keeping patients healthy at home.”

The report is highlighted by three key recommendations to help enable future home health agencies to recognize their full potential:
1. Reduce regulatory barriers to risk-sharing and empower home health agencies to be a full partner in care coordination.
2. Allow more flexibility in delivering home health care through alternative payment models. This includes testing waivers of certain regulatory limits to encourage clinically appropriate and cost-effective practices.
3. Crack down on home health care fraud by identifying hot spot areas of aberrant claim patterns. Tackling fraud in this targeted fashion will enable greater confidence in the Medicare system and cut down on overall program waste.

Qualitative research, a literature review, case studies and the themes collected at the 2014 Institute of Medicine and National Research Council workshop, “The Future of Home Health Care,” were all utilized in completing the analysis, which discusses the current challenges the home health care industry faces, and lays out a framework for stakeholders to adapt to this changing environment. Specifically, the report describes the current home health care landscape, the status of proposed reforms, and where the industry is headed. The report also offers recommendations for Medicare officials to improve the way home health care is delivered to better serve a rapidly growing patient population.

As the American population ages, living longer with more acute and chronic conditions, the role of home health providers is expected to grow and change significantly. Policymakers will need to address these challenges so that home health agencies can fulfill their critical roles under Medicare’s Triple Aim goals, which seek to improve patient experience of care, increase the health of populations and reduce the per capita cost of health care. The shift toward value-based health care provides new opportunities for home health agencies to adapt to alternative payment models and to pursue more care coordination and risk sharing.

“As we move into the future of home health care, it is critical that Medicare and home health care evolve alongside each other to actively promote risk sharing and better manage patient care,” said Teresa Lee, Executive Director of the Alliance. “In the long-term, we expect to see home health agencies expand their role under alternative payment models and serve as key coordinators of care.”

In order to adapt to this critical role, future home health agencies will need to have newly strengthened capabilities. The FOHH report outlines four pillars that describe what a home health agency of the future would be expected to look like. Future home health agencies must:

• Provide care that is person-centered, respectful and responsive to individual patient needs. This will require the home health care industry to clearly define person-centered care and develop new measurement indicators to ensure its effectiveness.
• Provide care that is seamlessly connected and coordinated. The report found that there is an enormous role for home health agencies to play in coordinating care for Medicare beneficiaries. The current shift toward value-based care will likely lead to beneficiaries interacting with a wider range of health care providers—and often well after an acute event—so the home health agency of the future will be in a unique position to take a leading role in care coordination.
• Prioritize quality. Medicare’s recent efforts to transition to value-based care will require home health agencies to be more flexible in responding to changes in patient populations. The research performed for this report confirmed that an overwhelming majority of Medicare patients want to stay in their own homes and that many who use home health services are more likely to be older, have multiple chronic conditions and live alone. Home health agencies must provide high-quality care that allows patients to remain safely at home.
• Be technology enabled. Recent innovation has allowed patients to easily connect with providers to receive more intensive and specialized services. While this is critical for improving patient care, future home health agencies can expect to face significant challenges in adapting to new technologies because Medicare does not currently reimburse for many types of health information technology. Thus, agencies will find themselves under pressure to implement new technologies under increasing financial constraints.

“This framework reflects the enormous potential home health agencies have to be the primary driver of quality, patient-centered care,” added Lee. “The home health agency of the future will be a leader in care coordination and play a critical role in patient health that goes far beyond post-acute care management. They have the opportunity to be a key partner in improving patient health, breaking down barriers to access and lowering costs for everyone.”

To read the full article, “The Future of Home Health Care: A Strategic Framework for Optimizing Value,” published in Home Health Care Management and Practice, click here.

Visit ahhqi.org for more information.