Stephen VaccaroTechnology in the homecare space is growing by leaps and bounds. New devices come out every day that promise to make aging in place easier for seniors. But, with all that technology, it’s important to keep the person first. And with the rise of value-based care, there is not only a greater focus on how the social determinants of health affect how and where someone ages, but how homecare agencies can step up to address any issues. And technology will play a key role in that, said Stephen Vaccaro, president of HHAeXchange, a provider of homecare management solutions for payers, providers and state Medicaid agencies. Below, Vaccaro shares his thoughts on the growth of technology in the home and what’s next for value-based care. 

HOMECARE: Value-based care is such a nebulous term that I think the industry is still coming to grips with it. What does it mean to you?

VACCARO: Well, you know, value-based care to me is all about improved outcomes. That really what everyone's trying to achieve. So the question is, how do you successfully achieve value-based care? Right. I think that the feeling out there, and I agree, is that you really need to start thinking about how you change your reimbursement model between payers and providers. And as you start to reward the, the entities that deliver the best care—that's where value-based care starts to become about who's delivering the best care. 

And the other part of it, I think that's critical, when you think of homecare specifically a lot of it really comes down to everyone thinking more broadly about the caregiver who's in the home delivering these services and really thinking of them as a critical member of the care team. Often iit's that caregiver who spends more time with the individual than anyone else, and they know when something's changing or something's different and they could make folks aware so that proper intervention could occur. So I think that's where it really starts to become critical. And you know, with the aging population, folks want to age in place in their home and community. All these pieces start to build into value-based care and changing the reimbursement model.

HOMECARE: So to your point, we know the patient can receive the best care possible under these value-based care models. But if they're struggling with food or housing insecurity or loneliness, that care doesn't mean much, they can have other issues going on. So how do homecare providers assess these issues and provide the right care?

VACCARO: I think the key there is for providers think about how they leverage technology, right? That’s how you start to address some of these items around, you know housing insecurity, food insecurity social determinants of health. Loneliness, which is critical. Some of that is leveraging technology so that they can get more visibility, real time into the home. You know, at HHAeXchange, we offer a solution we call Care Insights that a number providers utilize. And basically the caregiver, via mobile technology, is able to real-time report or answer questions from the home. So when they come to check in for a shift, they could answer questions are the carpets loose in the house or has the patient been eating their food over the past day? … So you start to understand if they or eating, or are the meals not getting dropped off. Or is the sidewalk still have snow and ice on it and nobody's cleaned it. And now we have a tripping hazard. These are things that can really start to impact care, and ultimately, improve the overall outcome of care that the individuals are seeing.

HOMECARE: So you kind of touched on this a little bit, but how does technology play a role in mitigating the risks associated with poor social determinants of health?

VACCARO: I mentioned one technology, right—Care Insights from HHAeXchange, and how the caregivers are able to be engaged and become part of that care team. There's a number of other technologies out there that are doing real-time monitoring—blood pressure monitoring, things of that nature—that are leveraging taking the individual's weight each day that you come into the home. The caregiver comes in the home, takes the client’s weight, and notes if something has changed. Is there a need for intervention? 

So, when you think about technology, that's what it's really about: How do you get more information from the home to the providers or to the payers and or to the family members. So that proper intervention is able to happen. And the key with it is not just raw data, then you don't know how to act upon it. It's being able to take that data and figure out at what, trends or what responses require an alert and what type of an alert is required and who should it go to so that the proper person is notified.

HOMECARE: Why is population health monitoring needed? If you have all these technologies in the home and you're getting all this data, what do you build with that? What do you design out of everything you get?

VACCARO: So, you know, population health, that's an interesting term, right? It's broad, but it's important, right? When you really think about population health, you think about how you leverage data from many different sources. They may be sources from the home, from the hospital, from the pharmacy. Are people doing their refills? Are they taking drugs that they should be taking? So you could do predictive analytics with the data, artificial intelligence, with the goal being again, how do you ultimately improve health outcomes? Because that's what all this is about. At the end of the day is how do we get a better outcome? So that individuals live the life that they deserve and they want in their home and community.

You look for patterns of health determinants. That way you see there are certain things that happen in certain geographic areas. And maybe there's interventions that you need to take in those geographic areas. Then again, I go back to, it's a lot of data with population health, but the key is determining when an intervention is required, and who should be doing that intervention. Is it a nurse? Is it a doctor? Is it, the person's lonely and you need someone to come and be a companion for them or set them up with some kind of a group setting. So it's understanding those dynamics of, of the data and then being able to figure out the best care the best intervention forward.

HOMECARE: So, big picture question. What's the future of care in the home look like to you?

VACCARO: My view is homecare is that it's here today, and it's only going to grow. We all know about the aging population and their preference for aging in place. We know about all those things, but it's critical for society as we go forward. People don't want institutional care. They want to be in the home. They to be with friends and family or in their community. And so I think homecare is the way that we address that as a society. And we need to do a lot more than what we're doing today. I think we're kind of in the early stages, in all honesty, I think of homecare and how we leverage homecare and the things that we could do at home.

You know, a couple things though, are critical for us to do this successfully as a community. One, the caregiver shortage. That's a major problem that's out there today. That has to get addressed. A number of folks are looking at different, innovative ways to address that, but that's critical. Because it all comes down to the caregiver. If you don't have the caregiver, you can't have folks in the home, it won't work. Two, how do we continue to innovate technology solutions to be able to capture more information from the home to make the caregivers more efficient while they're in the home and to better serve the individual that's aging in the home and allow them to live the life that they deserve and they want.