While value-based purchasing has experienced some pushback among some home health care advocacy groups, particularly in areas where it is now required, providers are well served to get on board and adapt to the changes.
This was the message among a panel of industry leaders who spoke last month during the Visiting Nurse Associations of America’s (VNAA) annual leadership conference in San Diego.
But, they say, there are several keys to adapting to the new model, including, above all, proving the worth of home health care among the health care continuum. Additional areas of focus for providers are program alignment, program characteristics, quality, safety and culture.
“As we align with the value-based market, we have to show what we can do for [health care partners] and prove the value of our home health care experience,” said Marki Flannery, executive vice president and chief of provider operations, Visiting Nurse Services of New York (VNSNY). “Some things we do, the market doesn’t necessarily do. We call, monitor, visit, act on what we learn and see… in our organization, we focus on making sure the population health team is managing the care of our patients.”
Working in the value-based market requires not only educating partners as to what sets home health apart, but also understanding the value all parties provide in the process—and seeing it as that, a process, rather than an event.
“Stop thinking about [care episodes] as projects and start thinking about them as a journeys,” said Margherita Labson, executive director, home care program for the Joint Commission. “It’s difficult if you think of it as a quality improvement project. It’s important to do a data-driven analysis.”
That data, however, may rest on systems that are not in full alignment, which presents a challenge that can be difficult to combat: proving the value of home health.
Communication can help address issues relating to systems and technologies, Labson said.
“The transmitter doesn’t transmit in a fashion the receiver can receive,” she said of the communication challenge. “Make sure you understand ‘this is what you’ll accept from me,’ and vice versa.”
Once they are able to communicate with hospital and other health system partners, home health providers have a lot to promote when it comes to demonstrating outcomes and cost savings.
At VNSNY, the organization has started a number of value arrangements with insurance plans, showing that rehospitlization rates can be reduced when home health care plays a role in the post-discharge care. The company is also working with a hospital partner to pilot a program where home health care works to prevent ER visits in instances where patients are most likely to call 911. The focus is on evaluating whether changes need to take place in the home toward this end—from medication reconciliation to identifying social determinants.
“Things like the home environment, caregiver strain index, ability to afford meds, access to transportation… if patients don’t have easy access, they are not going to go. These are reasons for rehospitalization,” Flannery said. “Our job is to show the partners they need us.”
Written by Elizabeth Ecker