Affecting care delivery in the home
by Cheri Bankston
January 14, 2019

By 2060, the number of Americans aged 65 years or older is expected to double to nearly 100 million. As it stands today, the American health care system is not equipped to provide the level and quality of care this aging population deserves at a reasonable and sustainable cost.

Much of the issue lies within post-acute care, which accounts for up to 25 percent of a Medicare Advantage plan’s total costs, 20 to 25 percent of which may be wasted for a couple of reasons:

  1. A lack of interoperability across care facilities that leads to errors or even readmissions.
  2. An overutilization of services, such as physical therapy, for specific conditions, or a patient may not need the intensive care provided at the long-term acute care facility or skilled nursing facility (SNF) to which they are discharged.

As both the senior population and challenges for post-acute care grow, and as providers are held responsible for better patient outcomes through value-based care, providers should look for more effective post-acute care options. Home health can fill that role.

Following a hospital stay, patients want to return home as quickly as possible, and in many cases, providers can accommodate this desire without a negative impact on patient recovery. In fact, patients often recover faster both physically and psychologically at home, provided they have the proper resources. Not to mention, homecare is often more affordable than most post-acute care facilities, making it attractive to providers implementing value-based care.

Consider that patients sent to SNFs and other post-acute care providers are rehabilitated by a professional, leaving the patient’s family caregiver hands-off during recovery. As a result, these family members don’t gain the experience needed to help the patient continue their recovery at home later.

Similarly, patients under the 24/7 care of a SNF may become more reliant on their caregivers than a patient living at home who receives periodic visits from a homecare clinician. Home health patients learn to recover more independently, making them better equipped at self-care and lowering their risk for readmission.

However, there are some instances where caregivers can’t provide adequate support at home. In those cases, clinicians should push for shorter recovery periods at a SNF before moving the patient to home health, rather than reflexively discharging patients to a SNF or other inpatient post-acute care facility.

Clinicians are in a powerful position to advocate for better patient care and speak up about the benefits of homecare over another post-acute facilities.

4 Ways Clinicians Can Influence the Shift to Homecare

1. Establish a home health specialty. As hospitals and health systems dive more deeply into value-based care, they’re looking for high-performing partners that not only provide quality care, but can keep costs low and reduce readmissions. Demonstrating results in these areas will be more attractive and valuable to providers than jack-of-all-trades agencies.

Home health agencies should consider focusing on a particular type of care, condition or recovery, and market this specialty across their provider networks. Begin by identifying care gaps in your local hospitals.

For example, a hospital that performs a high rate of hip replacement surgeries has an obvious need for postoperative care and will seek partners with a proven track record of experience and success.

2. Stay informed. It’s important for home health clinicians to understand the nuances of emerging payment models and other health care legislation in order to develop and deliver the highest- quality, lowest-cost care plans for your patients. Similarly, being well-versed in the legislative landscape will help you understand (and communicate) how patient outcomes impact providers and partners across the care continuum.

For instance, in October 2018, close to 1,300 health systems joined the Bundled Payments for Care Improvement Advanced (BPCI Advanced) initiative, which encourages providers and suppliers to better coordinate care by providing a single bundled payment for a service that would otherwise be spread across multiple providers. BPCI Advanced also keeps providers on the hook for financial penalties from readmissions for 90 days.

Being able to speak intelligently about your agency’s role and success in these or similar initiatives will help you make the case for home health as a more prominent player in the care delivery plan.

To stay informed, consider subscribing to health care business and regulatory newsletters, independently researching the latest proposals and mandates, or actively developing relationships with local health systems’ business development or strategy teams.

3. Keep up with new technology. New technologies are not only enabling providers and clinicians to make more informed decisions about care treatment plans; they’re also allowing for better remote patient monitoring, thus reducing the number of home visits needed and increasing patients’ independence. The best part? In many cases, these devices are already in people’s homes.

For example, heart rate monitors can wirelessly transmit data from patients at home to physicians in case there’s an irregularity or underlying issue that can be mitigated before patients are readmitted. Similarly, patients can wear a fitness tracker so clinicians can measure their activity and heart rate without even entering their home. In 2018, the FDA cleared the Apple Watch 4 to perform an electrocardiogram (ECG) and detect atrial fibrillation, which will pair with the watch’s fall detection and emergency SOS capabilities. The ECG app was released Dec. 6, 2018, as an OS update.

Non-wearables can help too. For instance, clinicians can program a patient’s Amazon Alexa or other home assistant device to send medication reminders that can help ensure that patients receive a consistent dose. And using Skype, FaceTime or another video chat service for regular check-ins with patients can give clinicians a much clearer picture of how their patient is recovering than traditional voice call.

Educate and encourage patients to incorporate technology into their recovery program, and document the results. For example, take note of any times you potentially prevented a readmission by sending immediate care to a patient whose fitness tracker displayed a concerning heart rate, and communicate these stories to hospital or health system decision-makers as evidence of how your agency is facilitating better patient satisfaction, outcomes, quality and readmission rates.

4. Campaign for interoperability. Interoperability of tools and the seamless exchange of data between home health agencies and other health care providers are essential to effective patient recovery. Currently, most patient data is siloed and unique to each facility, stifling the ability to make informed decisions about patient care and effectively measure outcomes.

To facilitate interoperability, clinicians should prioritize delivering patient data and results in a timely manner and share information about their patients that dot the line between medical incidents and the patient’s daily activity. Since home health clinicians are on the front lines with patients and are also plugged into health systems, gathering key information about patient condition and recovery uniquely positions clinicians to promote interoperability.

Affecting Change in Care Delivery

As value-based care gains momentum, patient information is made more fluid, and new technologies and tools emerge, home health is becoming a more attractive option to manage the burgeoning population of seniors. By following these four tips, homecare clinicians are poised to drive change and propel lower costs and better patient outcomes throughout the U.S. health system.