High-Tech Home Care

What’s next in technology-enabled home care services? Are you convinced the future will bring changes to service and standards of care? How many home care providers will seize these new business opportunities to create a more valuable niche in the nation’s health care delivery system?

Before you answer, take a look at the following scenario involving home care for a congestive heart failure patient. It demonstrates how providers can participate in new value-producing services and the new standard of care.

A Look into the Future

The patient requires periodic home health support, continuous infusion and oxygen therapies, multiple oral medications and equipment to assist with ambulation. Services are also provided by pharmacies, physicians, hospitals, laboratories, etc. Data on our CHF patient is submitted continuously to the patient’s electronic medical record from:

• Portable devices carried by clinicians during home visits.
• Devices and information systems capturing data at the pharmacy, lab, physician’s office and acute care facility.
• Billing and claim information databases.

Continuous monitoring data also flows into the home care provider’s office from the following electronic devices and patient interactions:

• Biometric devices and monitors (multiple measurements and pictures).
• Oxygen and medication delivery devices (pumps).
• Patient communication devices — data, voice and visual.

An expert system generates an alarm whenever in-office continuous patient monitoring indicates that oxygen saturation falls below preset levels. For our patient, the frequency of the alarms is increasing, causing the HME provider to generate a graph of oxygen flow rates and saturations over time. In addition to the frequency, the alarms are occurring more often at certain times of the day.

The HME provider does three things right away: (1) reviews the patient communication record to see if questions or problems have been submitted that may indicate compliance or equipment problems; (2) reviews other vital sign records for changes in medical condition or changes in care, such as changes in medications or dosages; and (3) sends a question to the patient asking if he is aware of any changes.

When the provider discovers that the equipment is working properly and the patient is not aware of a problem, the patient’s physician is notified that a clinical development may require a reassessment and/or a change in orders. The physician reviews the same home monitoring records and schedules a virtual office visit in the patient’s home to determine whether an actual office visit is needed.

The HME provider also notes that many low saturation events are occurring at night, so barring any other findings, the patient should be assessed for potential sleep apnea. At the same time, the infusion provider researches the record to see if vital signs and weight trends indicate that drug dosing needs to be increased to better support the patient’s cardiac output. They have an expert system that compares all current medications and dosing to prevent duplications and drug interactions.

The patient can access a portion of the record showing these events and add his self-assessment at any time. The HME provider does a follow-up remote assessment to see if the patient needs additional equipment to support the change in condition.

Once the reassessments are done by each provider, contributed to the EMR and new orders are given if needed, the patient’s care has been updated through a series of proactive services without visiting the home or waiting for a more costly patient care event.

The aging of America and increased utilization of conventional home care services will certainly help the home care industry, but they are not sufficient growth factors to ensure the long-term financial and competitive success of home care providers. Taking advantage of technology is becoming a critical survival factor.

Doing nothing turns providers into stationary targets for recurring reimbursement cuts, allows the continued devaluation of conventional home care services and prevents participation in the new standards of care. Fighting back not only secures the role of home care in the future, but technology-enabled service development will become an essential strategy for compounding revenue growth and preserving profitability.

Responding to HomeCare’s 2005 Forecast Survey, home care providers said that 16 business issues posed a bigger challenge for their companies than keeping up with technology. At the same time, a 2004 CIT Healthcare Industry Survey revealed that 93 percent of providers and 87 percent of DME manufacturers said the health care industry was either “somewhat likely” or “very likely” to face continued pressure to improve information technology capabilities in the coming years.

To some providers, this pressure may appear to be a business problem representing increased complexity and costs. In reality, there is a door opening to cost savings and new service opportunities. The technology-enabled future can be a rebirth in the value of home care services.

Federal Policy Is Driving Technology Adoption

The adoption of a new technology-based value proposition is more than “continued pressure” — it is now an industry-wide mandate. Just ask home health agencies if major changes in the health care business playing field can make or break businesses. More than 30 percent of HHAs were lost as a result of the implementation of PPS (prospective payment system) reimbursement methodology in 2000. Now, home health is emerging as a leader in home care technology adoption.

Last July, former Health and Human Services Secretary Tommy Thompson introduced “The Decade of Healthcare Information Technology” and released the outline of a 10-year plan to build a national electronic health information infrastructure in the United States. This plan accelerates the process of technology development and implementation throughout the U.S. health care system.

HHS is not alone. Other federal agencies have also increased funding for health care technology research and development.

We also know that Medicare is headed for a financial crisis. Reimbursement levels for Part B services have been lowered, and political pressure has resulted in a costly new Part D drug benefit in 2006. Medicare’s seemingly impossible financial goals cannot be achieved by maintaining the status quo in health care delivery; meeting them will require revolutionary change.

The Medicare Modernization Act of 2003 set a new direction for health care policymakers. As a result of MMA, we see six major policy trends, and most are technology-dependent in some way:

1. Electronic data collection and information management;
2. Better and more timely patient care decisions;
3. Improvements to the quality of patient care;
4. Patient access to information, so consumers can be involved in managing their care;
5. Lower reimbursement for conventional products and services (e.g., competitive bidding); and
6. Improvements in care planning and patient management, particularly for chronic disease.

HHS knows that reimbursement cuts are reaching a practical limit, so technology adoption is the only underlying change that can enable Medicare’s future stability. Providers with a larger commercial payer base may get a six- to 12-month reprieve, but once proven, new standards of care and reimbursement methods will also be adopted by commercial health plans.

Alternate Site Technology Development

New health care technology applications fall into two major categories: (1) patient care technology and (2) information technology.

The health care industry is unique in that the customer, or patient, typically receives services from many separate, independent providers. This difference specifically impacts the path and the process of health care technology adoption.

It’s information technology that creates a unique environment where more and more digital information needs to be compiled and shared among all the parties providing care for a given patient. One result is a unified, electronic patient record that enables better, more coordinated care and more efficient utilization of resources.

Technology solutions with no potential to enable new services or create new value are not the source of radical change. But steps in technology adoption, like abandoning paper records for electronic records, are permanent developments that change the basic home care paradigm and value proposition, and enable changes in reimbursement. (See illustration on pg. 40.)

Enhancements or incremental improvements to existing products and services are typically not capable of producing such change. They may be well-received by patients and referral sources and offer some incremental revenue opportunities, but on a larger scale, it is radical improvements that provide the impetus for changing care delivery methods, standards and reimbursement.

There may be some guidance from HHS policy, but don’t assume that CMS or other regulators will dictate the software or equipment required to meet the new standards. There are many choices and options when evaluating potential technology investments.

Remember that time is a factor to consider. Technology development and adoption may appear to be a long-term process that involves planning and long implementation cycles, but a new application might only have an 18-month life span before a major revision or replacement is introduced.

The New Technology-Based Home Care Value Proposition

The new value proposition is based on a technology-empowered revolution in the value of home care services, which also enables improvements in the financial health of home care providers.

Value creation is the only source of significant new or increased revenue. Just ask a salesperson who has tried unsuccessfully to sell a feature-laden new service that offers no significant new value.

We can build on the old value proposition that home care is much less expensive for payers and patients, and that patients have better outcomes in the home. Technology applications can add new value through:

• Revolutionary improvements in access to home care for more acutely ill patients;
• Significant improvements in the amount and quality of care;
• Lower costs or improved management of the cost of care; and
• More timely patient care management decisions.

Technology for technology’s sake — sort of the bell-and-whistle quality — is not the source of value; the patient-care services and care decisions made possible by the technology create value.

Without question, the technology adoption process appears to favor larger, better-funded providers who are better able to invest money and resources in significant technology improvements, but this is not necessarily the case.

Smaller providers need to realize that technology tends to level the playing field for all providers. Just as the Internet created a level playing field for large and small companies, technology-enabled home care services will allow small companies to look like very large companies in the way they operate and compete.

Four Key Technology-Based Revolutions in Home Care

With improvements in information management and patient care as the basis for new services, four key changes will create value improvements, lower costs and open the door to new revenue opportunities.

• Revolution No. 1: The Electronic Medical Record Using the integrated EMR, all providers of care for a given patient are identified as authorized contributors to the patient’s record. Patients and payers are included; they occupy the vertical space in the information sharing process shown in the illustration on this page. Once the patient record becomes a seamless, living, changing electronic document, a one-size-fits-all care plan is not going to work. Monitoring and interpreting the information in the record and recommending actions that improve care and/or lower costs is the value-producing activity that will allow new service and revenue opportunities. Will you have the expertise to implement new patient management services based on the EMR?
• Revolution No. 2: Expert Systems In the future, clinicians won’t be the only ones analyzing the patient record and looking for opportunities to improve care or solve a problem. The electronic patient record contains vast amounts of information submitted by physicians, acute care facilities, home care providers, pharmacies, laboratories, radiology, billing, and on and on. Identifying all the potential opportunities for improvements or problems, such as conflicts between treatments like drug interactions or a duplication of services, is beyond the cognitive capability of any one clinician. There is a real opportunity to compete by updating your expert system capabilities. Many expert systems will incorporate learning capabilities. The more you use the system and give it patient data and actual results, the better the system is able to identify potential problems and solutions, and that creates a competitive advantage for the provider.
• Revolution No. 3: Remote Patient Monitoring The current state of the art allows for the 24/7 collection of patient vital signs, visual information and other measurements transmitted to the provider on an intermittent basis. Ultimately, providers will be receiving real-time data from their home-based patients on a streaming, continuous basis. At that point, won’t home care have many of the same technical capabilities as an ICU? Many hospitals have already implemented eICU systems. Remote data collection and transmission is an old technology, but the home care service opportunities created by this development are dramatic. More frequent data transmission allows the acceleration of the number of opportunities to review patient progress and make patient care decisions. With continuous data, providers can witness events in real time along with the patient’s monitoring device measurements, voice and visual data. This is the revolution that will become the new standard of care.
• Revolution No. 4: Patient Communications New communication pathways will enable much more access to information and participation by patients and caregivers. As today’s informed patients start utilizing new communication methods, they are becoming much more involved in decisions regarding their care and how their health care dollars are spent. This is the new “patient-centered” approach.

There are significant benefits associated with interfacing with an informed, participatory home care patient. Using the phone or the Internet or another communication device, patients can contact the office at any time. Interactive Voice Recognition (IVR) technology, a standard now in some retail pharmacies, allows automated assessment of the urgency of incoming calls and messages, and who, if anyone, should get the call and when.

A Wake-Up Call

More interactive, coordinated, proactive care — with lower costs, more access to information and better service — is a key component of the new value proposition for home care. The door is open to new service and revenue opportunities that ensure growth and profitability, and home care’s renewed value in the future health care delivery system.

The industry mandate for technology adoption requires that home care providers start embracing this new value proposition. The planning, purchasing, training, implementation and service development processes take time, so having a technology plan is the first step.

Make 2005 your year to develop a serious plan for becoming a successful participant in the “Decade of Information Technology” revolution in health care service delivery.

Mark R. Riddell is a health care business expert and consultant. His company, The Marrell Group, provides management and business development solutions to alternate site health care companies, including online services at www.marrellgroup.com. He can be reached by e-mail at [email protected] or by phone at 832/724-8267.