Uncertainty is nothing new for home health providers. Since becoming a Medicare benefit in the mid-1980’s, the only constant was change. The past year featured more uncertainty than normal, as 2017 saw a number of challenges arise for home health providers, both from a regulatory and business climate perspective. Much of the year was spent in anticipation of the finalization of the HHGM while providers simultaneously prepared to meet the new Conditions of Participation. Meanwhile, the public reporting of data paired with the narrowing of healthcare networks put a different type of pressure on agencies across the country. Several states were involved with pilot demonstrations while many regions of the U.S. experienced caregiver shortages. With so many challenges in the industry, we wanted to know more about what providers were thinking, so we surveyed agency management across the country to find out what their top priorities were. The overall results are highlighted in this graph.With so much uncertainty related to compliance, change, and the overall healthcare environment, we decided next to turn to experts in home health. In this eight-part series, we follow along a mix of home care experts to obtain a variety of perspectives with their thoughts and ideas.
The home healthcare industry is undergoing a significant transition driven by healthcare delivery reform efforts and budgetary constraints at all levels. A critical element of success will be creating an updated perspective on the value of home-based care in modern healthcare delivery models. The home-based care industry can and must advance a new narrative to highlight our value.
The reality is that healthcare delivery models increasingly emphasize the quality and value benefits of driving care outside of institutional settings and back into the home and community. Payers, providers and consumers all seek to provide care in less expensive, patient preferred, high-quality settings. New healthcare delivery and payment models incentivize physicians to develop preventive, proactive and longitudinal relationships with patients that extend beyond the office walls and seek to prevent hospitalizations and exacerbation of chronic conditions.
Wellness, health promotion, disease management, care coordination, system integration, patient engagement and education and caregiver support have become critical components of successful delivery models – regardless of whether those physicians operate in a traditional practice model or in health systems or Accountable Care Organizations (ACO) models. Hospitals, too, face new challenges to prevent repeat hospitalizations. Hospital payment guidelines and quality measures require post-acute services that extend into the community, into the home, and require the provision of services necessary to ensure patients and caregivers are knowledgeable, empowered and activated to continue recovery outside the acute care setting. Perhaps most important, the scope of populations served through these models will only continue to grow.
Home-based care providers, including traditional home health agencies, are the backbone of community-based care. These providers can play a central role in new healthcare delivery models that emphasize community-based support across the continuum of care. Home health episodes for post-acute services have been demonstrated to be less expensive and to have quality outcomes on par with or better than more expensive in-patient settings such as skilled nursing facilities for certain patient populations. Home health plays an important role in health promotion and management. The Medicare Payment Advisory Committee (MedPAC) in 2017 noted that 60 percent of Medicare home health episodes were not preceded by an acute episode or hospitalization. This means agencies are increasingly supporting chronic care management and health promotion and prevention programs in efforts to prevent exacerbation of conditions that may lead to Emergency Department visits or hospitalizations.
Why then, is home-based care not recognized, engaged and reimbursed as a central component of high quality, lower cost, patient-centered healthcare models?
As physicians, hospitals and health systems have aligned and adjusted in new care delivery and payment models, they have increasingly sought to build “in-house” home care capabilities that operate outside the traditional, episode-based home care delivery model. This “reinvention of the wheel” has increasingly cut out of the payment model traditional home health agencies. Further, where agencies have successfully fought for a seat at the local provider table, they are frequently offered payment rates far below their costs of care.
We must change the narrative to highlight value, quality and integrity. We must further engage partners to advance and support this new narrative.
Operationally, home health agency leaders can implement new business models and develop new partnerships among payers and provider partners. Many agencies across the country have already begun this transition. Agency leaders can examine current business practices and performance indicators and align these metrics with the needs of provider and payer organizations within their communities. This alignment can support the development and launch of new programs and operations outside the traditional 60-day episodic model. Key indicators for consideration include quality outcomes scores for local hospitals and payer organizations. Identifying where an agency can help these potential partners improve quality scores and outcomes allows for informed and productive proposals for partnership and appropriate reimbursement.
In conclusion, the home healthcare industry must continue to achieve and demonstrate success in new care delivery and payment models. These models require innovative partnerships with payers and providers who require home healthcare agencies to provide high quality and lower cost care. Most important, the home-based care industry must change the narrative to focus on quality, value and integrity to reposition and reinforce home health as a critical and central component of healthcare delivery.
Join us next time in Part II of our series where Healthcare Market Resources President Richard Chesney gives insight into the Centers for Medicare and Medicaid Services and their approach to home health reimbursement.