In last week’s post we covered the first of two risks to the Home Health industry, and those for whom we provided care. This week we will address the second, at risk relationships – ACO’s and ACO like concepts, as well as, other bundled payment concepts. In all of these “at risk” relationships Home Health has the opportunity to truly be the care setting of choice as Homecare often provides the most clinically appropriate care at the most cost effective price point. In this regard, the Home Health industry is uniquely positioned to capitalize on these bundled payment initiatives, as it is the most cost effective player within the post-acute continuum. However, in order to prove Home Health’s place in this future structure it must truly prove that it can control hospital re-admissions and that its care protocols can in fact have a predictably positive impact on total post-acute spending. As these payment models evolve over the next few years it is critical that the Home Health industry begin to build care models that can impact outcomes so that it is positioned to play a value added role in these evolving at-risk relationships.
No matter what the future holds or when the evolution in payment models occurs Home Health can be certain that the current model is changing and now is the time to prepare for that change by focusing efforts in a few key areas that will prove valuable regardless of exactly what form future reimbursement takes. In our opinion, Home Health’s primary areas of focus should be:
- Developing care transitions models that focus on how to ensure that patients avoid re-hospitalization by front loading care and even increasing visits early in the episodes of care.
- Increasing the effective use of certified nurse aides and health coaches to provide more frequent interactions with the patients to proactively identify re-hospitalization risks
- Developing ways to touch the patient more often through enhanced use of tele-monitoring or telephonic contact
- Controlling cost per visit of all of our care giving staff by developing improved payment models and enhanced productivity controls so that the added investment in patient touch points can be managed without significant financial implications
- Developing protocol based care pathways that outline the right mix of visits by the right skill level staff member to achieve the desired decline in re-hospitalizations. In addition to frequency planning these pathways must also clearly address the areas of highest risk to be managed early in the episode.
Developing core relationships with physician house call programs to enhance the level of physician involvement for high risk patients.
Improving Home Health’s re-hospitalization rate should be its highest priority for the future and is the thing that will have the greatest impact on the industry’s long-term future. In the meantime, focusing on these models of efficiency and quality will have a minimal negative impact on our current cost structures and will ultimately position the industry for long term success in a future that will no longer be driven by fee for service models.