Innovating to Improve the Quality of Post-Acute Home Healthcare
A major challenge in healthcare is delivering the right type of care at the right time and for the right duration. That’s especially true for post-acute care following a hospitalization when lack of proper follow-up care and inadequate supports put patients at high risk for complications and hospital readmissions.
Among the factors that impact a patient’s recovery is the setting in which it’s provided. While skilled nursing and rehab facilities were common choices for recovery, home-based care has also become an integral part of the post-acute spectrum of patient care, as an appropriate option for Medicare members.
At the same time, providers face a number of challenges in providing access to in-home services that meet the needs of their patient population. Key among them are shortages in skilled clinicians, which have left many home health agencies understaffed and unable to take on rising referrals. This is particularly true in certain areas of the country where major imbalances exist between the region’s substantial and growing aging population and the number of clinicians available to serve them. Adding to the problem are payment models that can disincentivize providers from taking on patients in need of higher-acuity care in the home.
Health plans, however, are utilizing technology to better predict the future healthcare needs of their member population. They then can design value-based models that enable providers the flexibility to innovate to help ensure provider networks are more prepared and equipped to meet patient demand.
Predicting needs and outcomes to help improve the quality of home health
The first step in improving the quality of post-acute home-based care is understanding population and home health trends to predict future healthcare service needs. Machine learning models informed by vast amounts of claims data containing a wide array of clinical and demographic details can help to better predict home health outcomes. Drilling down to specific geographies, age groups and health conditions, as well as individual provider’s quality of care, among many other factors, enables payers to optimize their provider networks and design the right payment models and incentives that address their members’ needs.
Analyzing these trends and the services associated with positive outcomes can also help direct the appropriate services and duration of care to patients who would benefit most from them – which is especially critical where home health provider capacity is constrained. Providing the right level of care for a patient’s particular acuity level helps maximize access to post-acute services for the entire patient population.
Enabling innovation through value-based care
Value-based care encourages the reimagining of care approaches. That may include the use of virtual visits, monitoring technologies and AI systems that reduce administrative load and increase efficiencies so clinicians can spend more of their time caring for patients. Innovation can also take the form of being more prescriptive about the type and regularity of care a patient needs. Determining the right mix of care, which may include in-person and telehealth visits, along with remote monitoring, can free up clinicians to care for more patients, particularly necessary in rural and underserved areas of the country. The reimbursement structure in value-based care models is designed to reward providers based on improved patient outcomes that reduce the total cost of care, offering them this flexibility to innovate.
Aligning care models to population needs
Value-based care arrangements also align incentives for both the payers and the providers with the various post-acute needs of their member population. For instance, a health plan may see that a segment of the member population in a particular state has a high rate of an acute condition that often results in hospital readmissions. Payment structures can then be redesigned to align reimbursement rates to help improve outcomes within a specific population segment. Doing so can increase the number and quality of providers in a health plan’s network that align to improving that condition, which in turn will help improve access and drive down hospital readmission rates.
Value-based care is not a one-size-fits-all proposition. Payers can implement a wide range of value-based arrangements—from quality incentives to fully capitated models—depending on what best meets the population's care needs.
Utilizing predictive analytics and a diversified approach to delivering value-based care helps ensure payers and providers can meet the post-acute needs of their Medicare members. Accurately forecasting the clinical care required and the outcomes of those receiving home-based services, as well as enabling innovation with value-based arrangements, can help overcome barriers to high-quality post-acute home-based care for patients in need of those services.
Cassie Houff is Vice President of Post-Acute Care Solutions for OneHome, an integrated post-acute solutions organization specializing in coordinating home-based healthcare services. OneHome is a subsidiary of Humana, a leading health and well-being company.
