Explore New Service Opportunities

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By Bill Belecz 
CIO and Vice President, Visiting Nurse Service of Rochester (NY)
Managing from Strength Creates Engaged Workers

Standing still is not an option in the home care industry. Stop for a minute, and the competition and regulations are likely to pass you by. But creating new programs may help you not only catch up, but pass the competition.

An overwhelming majority of McKesson Homecare™ and McKesson Hospice™ customers last year cited declining reimbursements (74%) as the top challenge facing their organizations. The only other concern gaining a majority was cost containment (53%), according to the Organization Opportunities and Challenges Executive Survey.

Visiting Nurse Service of Rochester (NY), part of the University of Rochester Medical Center, has been providing care for more than 90 years and completes more than 600,000 annual visits for 11,000 patients.

In order to help face the challenge of declining reimbursements, we continually explore new service offerings that leverage organizational expertise, solve pressing issues for patients and partners, and provide new sources of revenue. Programs are periodically reviewed for effectiveness as well as clinical and financial performance. For example, we recently introduced several new programs that we run either through VNS or through Visiting Nurse Signature Care, our private pay arm. Here’s a look at them:

Care Transitions Program. Using RNs and therapists, this program helps targeted patients learn how to advocate for their own health to avoid readmissions during the first four weeks after discharge. Candidates are specified by payers but typically include those who were in the hospital for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, pneumonia or such Prevention Quality Indicators (PQI) as dehydration or urinary tract infections. These patients are targeted because they have had more than one admission in the past year.

The intervention is designed to help patients self-manage their medications, understand and manage their personal health record, schedule and complete necessary follow-up visits, and learn how to recognize worsening of their symptoms. The first patient visit occurs during hospitalization, with a second in-person visit occurring 24-48 hours following discharge. Three phone calls occur, ideally at two, seven and 14 days post-discharge. Each visit or phone call has a specific objective that addresses the unique needs and goals of the patient.

More than 1,000 patients have been enrolled in the program, which has reduced hospitalizations by 25%.

Managed long-term care. We have partnered with a long-term care provider to manage care for more than 600 dual-enrollees on a per-patient per-month basis. Duties include coordinating access to covered and non-covered services and facilitating appropriate utilization. In the future, we expect to share risk.

Embedded care managers. We participated in a highly successful two-year grant program that embedded care managers into three primary care practices. The goal was to reduce 180-day Medicare readmission rates by focusing on patients at risk for PQI-related admissions and emergency department visits. In addition to identifying at-risk patients, we helped patients coordinate services, work through health and life issues and manage their chronic conditions. At the end of the grant period, the practices hired our workers and kept offering care management services.

Telehealth. Patients love telehealth, and our experience shows it can reduce hospital admissions and the need for emergent care. During a four-year program of CHF patients, those using telehealth showed a 50% improvement in admissions and a 42% reduction in emergent care when compared to non-telehealth users. Patient satisfaction was off the charts, with a satisfaction rating of 91% and a 95% recommendation rate to friends.

Nurse family partnership. VNS staffs this local health department initiative that targets first-time moms, following them from 16 weeks’ gestation to the child’s second birthday. We discuss health and life issues related to becoming a parent as well as monitor the health of mom and baby. The ability to grow the program is limited by county funding, but it provides a great service to the community at a good margin for us.

What opportunities exist in your market to coordinate services, become part of a patient-centered medical home or care for a new population?

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