Home Health, Other PACs, Play Larger Roles in Patient Journeys

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Billie Whitehurst By Billie Whitehurst, MS, RN 
Senior Vice President, Extended Care and Care Operations, Change Healthcare
Home Health, Other PACs, Play Larger Roles in Patient Journeys

Although health systems have consolidated over the past several years, few systems cover every aspect of a patient’s healthcare journey. In today’s care environment, however, reimbursement increasingly is tied to outcomes beyond hospitalization, such as 30-day readmissions penalties or episodic payments for certain conditions regardless of what provider delivered.

Consequently, hospitals are looking to partner with post-acute care (PAC) providers on care and reimbursement initiatives. PAC providers can include home health, inpatient rehabilitation facilities (IRFs), long-term acute care hospitals (LTACs) and skilled nursing facilities (SNFs).

“The trend toward value-based payments increasingly holds health systems accountable for post-acute spending and care, and a health system’s success relies increasingly on PAC providers’ cost, quality and overall ability to manage patient care,” according to a new white paper from Leavitt Partners.

“Post-Acute Care (PAC) Optimization in a Value-Based Economy: Bridging the Gap Between Hospital and Home” makes the case that effectively managing relationships with post-acute care providers relies on the six features listed below.

Here, those features have been analyzed through the lens of home health, and many play well into strengths that home health brings to every encounter.

Partnership approach

The relationship between PAC and hospital shouldn’t be top-down from the hospital. Rather, it should be a give-and-take for the ultimate benefit of the patient. Suggestions include creating an environment of safe learning, shared accountability and shared resources. In many of these relationships, the weakest link can threaten to pull down other providers.

Right site of care

Determining the best post-acute care environment for patients can be difficult in some circumstances. It depends on patients, their support networks, the type of illnesses/procedures that resulted in the hospitalization, co-morbidities and more.

The value of home health for MS-DRG 470 (major joint replacement without major complication or comorbidity) was shown last year in a study commissioned by the Alliance for Home Health Quality and Innovation. The study, which looked at cases between 2011-2014, showed that patients referred to home health after surgery had fewer 90-day readmissions than patients who went to SNFs or IRFs. Also, the per-patient cost of home health was half the cost for IRFs and nearly 60% the cost of skilled nursing care.

Analytics to measure PAC performance

It’s not surprising the report states, “PAC partners with an ability to leverage analytics can use more effective tools in a value-based arrangement.” Organizations that monitor their performance and outcome metrics and strive for continuous improvement should be more attractive to potential partners.

Engaging patients and family/caregivers

The nature of home health supports and supplements other caregivers, with not only education for patients and their families, but also with home safety checks, ongoing patient assessment and information about other community support services. This is an area where home health can rise above other PAC providers.

Effective communication and technology tools

Care coordination among acute and post-acute care providers can benefit from robust clinical software tools to effectively manage patient care, document that care and share data with partners. Systems used by provider partners should be able to send/receive information securely so that partners can better coordinate care. The same software also should be able to  drive your home care organization’s analytics to track outcomes and improve processes.

High-performing PAC network

Provider/partners should be on the same page in terms of incentives, best practices, quality scorecards and measuring performance against industry benchmarks, as well as regional and local peers. Providers should meet regularly to assess performance, monitor progress and outline quality initiatives.

In terms of cost and quality, home health stacks up well against other post-acute care providers. However, to compete against other PACs, you need to better understand your organization’s cost structure, your outcomes and your strengths.

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