What Is the Future of Post-Acute Care?

“Never let a good crisis go to waste,” Dr. Rasu Shrestha, Atrium Health executive vice president and chief strategy and transformation officer, said at Forcura’s CONNECT Summit.

In some ways, the COVID-19 pandemic—while it struck a financial and operational blow to many individual homecare providers—has shown the industry as a whole where it needs to focus its energy. What’s coming in the next 12 months?

Forcura, a communication technology company for home health and hospice, compiled the results of its summit in a report titled “What Happened and What’s Next in Post-Acute Care.” We’ve summarized some of the ideas presented here, with a focus on what’s coming next.

“It took a global pandemic to get us to take a step back and figure out how to optimize this industry,” Forcura CEO Craig Mandeville said in the report. “We’re reimagining how we can do more, especially in providing care at home.”

Here are the five themes that will emerge for homecare in 2021, according to the report’s findings.

1. Interoperability is critical.

As care becomes even more complex and requires more coordination—especially as patients move back and forth on the continuum of care—the need for information to transition smoothly between systems will become more and more important. Participants outlined the PACIO Project, where government and industry volunteers are collaborating to increase interoperability between post-acute and other care providers, patients and stakeholders. The goal is to help develop a new standard for exchanging health care information called Fast Healthcare Interoperability Resources, built on a platform approved by the Centers for Medicare & Medicaid Services (CMS).

“As patients move from one setting to another, there are plenty of opportunities for information to get dropped along the way,” said David Hill, principal engineer at the nonprofit research firm MITRE.

Also on the horizon next year, the CMS Interoperability and Patient Access final rule is an effort to give patients access to their health care data when and where they need it. The rule sets out new policies geared towards increased interoperability, some of which will be applicable in 2021.

2. Consumers will drive health care.

People are starting to make the same demands of their health care as they are of other services. Whether it’s remotely monitoring blood sugar or doing physical therapy on Zoom, technology is a tool that enables or enhances care delivery. At the same time, great care is the priority, especially when it comes to care at home.

What’s empowering consumers to demand care that they can better control? The accessibility of the right data, both their own health care information and analyses of trends, is educating patients about what to ask and how to partner with their health care providers. They’ve also witnessed family members or friends struggling with care in a setting that may not have been appropriate. Patients want each step of their health care journey to make the most sense for them and fit into their lifestyles as much as possible.

Of course, post-acute care has not yet benefited from the reforms enjoyed by other parts of the health care continuum. The silver lining (if you can call it that) of the pandemic: homecare gained major awareness from consumers, government and the financial sector. Patients saw what is possible when they are treated outside a hospital and now want to have that choice going forward.

“2020 (showed) us that we can do so much more to put the patient in charge of their health,” Mandeville said. “That means caring for each patient at the right level of acuity in their location of choice.”

3. Reimbursement plans & payment models remain in play.

The post-acute care industry will continue to be shaped by regulatory and financial forces. From these perspectives, what should your business do now to be at your competitive best in 2021? Watch for the extension of CMS waivers and temporary rules set forth in response to the pandemic.

The COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers are in place through the end of the public health emergency declaration. This includes waiving the 30-day OASIS submission requirement for home health agencies. Home health agencies (HHAs) may also continue to perform Medicare-covered initial assessments and determine patients’ homebound status remotely or by record review. It appears the majority of the changes put in place this year will become permanent in 2021.

The proliferation of Medicare Advantage (MA) plans will be top-of-mind in 2021. MA market penetration has grown from 19% to 2010 to 39% now, and is expected to hit 50% in 10 years, according to Corridor Vice President of Revenue Management Services Beth Prince.

MA plans are increasing the number of supplemental benefits not offered in original Medicare. According to Fierce Healthcare, an analysis by consulting firm Avalere found that one-third of MA plans will offer new pandemic-related supplemental benefits next year, and 94% of them will provide telehealth benefits for Medicare Part B covered services.

4. New business models are coming.

Post-acute care is being asked to deliver better patient outcomes and greater value–and it’s time to respond. There’s an explosion of home-based health care services from legacy players and new entrants.

Bill Dombi, president of the National Association for Home Care and Hospice, urged post-acute care providers to expand the breadth and depth of their services. He called for “better integration between health systems and home care” and believes that it’s up to the home health community in particular to grab this opportunity.

“As an industry, it has fast-tracked an amazing transformation,” Dombi said. “It’s leaner and more productive, has better communications and a greater tolerance for the unknown, is more technologically astute, and is looking at a population beyond the elderly.”

Homecare Homebase President Scott Decker said a quarter of skilled nursing residents could be treated at home and he sees a growing effort to switch the view of homecare away from solely short-term post-acute care.

“We need to build a model that starts with care from home and expands from that,” he said.

5. Health care for all remains elusive.

The novel coronavirus has revealed some harsh realities about the ongoing effects of structural inequity.

“By the end of August, half of those who had died from COVID-19 were people of color: Blacks, Hispanics, Native Americans and Asian Americans. It has become our ‘Katrina moment,’” said CulturaLink Founder Yolanda Robles. “The pandemic has shown a bright light on much of what we know about health disparities in the U.S. but have failed to consistently address. Now it’s time to talk about reducing the disproportionate burden of COVID-19 as well as improving the health of all people in our country.”

And racism isn’t the only driver of healthcare inequity; discrimination due to gender, disability, education, income, sexual orientation and even geographic location also factor into this epidemic.

Robles suggested that in 2021, providers pledge to:

• Increase collection and use of race, ethnicity, language preference and other socio-demographic data
• Increase cultural competency and diversity training
• Increase diversity in leadership and governance, providing a seat at the table
• Improve and strengthen community partnerships

When looking ahead from 2020, providers are hoping for more positive than negative lessons in the year ahead. Mandeville anticipates that the desire to be treated at home will drive a massive amount of innovation, with new entrepreneurs, investors and technology.

“Get ready to be inspired, challenged and to think bigger,” he said.