The value proposition of providing care in the home is simple: improve patient outcomes while providing care in the least costly, and generally patient-preferred, setting. Americans, especially as they age, prefer to age in place, which remains an option for millions of older Americans and those with disabilities thanks in part to the Medicare home health benefit.
To date, the role of home health care has been influenced significantly by Federal policies, particularly the Medicare program’s home health benefit. This framework, however, was not designed to support the rapidly growing demographic of older Americans, which estimates suggest include up to 10,000 new Medicare eligible adults each day. In order to better strategize a future framework for the delivery of care in the home, the Alliance for Home Health Quality and Innovation (the “Alliance”) initiated the Future of Home Health Care (FOHH) Project. The multi-step project aims to clarify the current role of home health care, improve understanding of how it will be used in the future for seniors and Americans with disabilities, and identify the key issues and challenges that need to be addressed to achieve improved health care in this context.
The Future of Home Health project will take place in four phases.
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- The first phase was the release of a White Paper to a policymaker audience in May.
- This fall, the second phase of the project will take place with a public workshop hosted by the Institute of Medicine and National Research Council’s Forum on Aging, Disability, and Independence. The workshop will improve the understanding of the current and evolving role of home health care in supporting aging in place and community-based care for high risk, chronically ill and disabled Americans.
- On January 13, 2015, the Alliance will host a symposium discussing key delivery reforms and emerging models of care in home health.
- Finally, the Alliance aims to release a research-based strategic framework for the future of home health care delivery in 2015.
As the U.S. health care system prepares for the future, seeking to leverage finite resources to pay for patient outcomes, home health holds significant potential to be a key player in health care delivery for older Americans and persons with disabilities. While a number of demonstration projects and programs are currently using or testing varying approaches to home health and home-based care, many with positive results, numerous questions still remain on how best to determine the role of home health care in the future of the U.S. health care system.
Despite the high value of home health care, certain payment and regulatory aspects of the Medicare program create obstacles to providing care. The current Medicare benefit requires patients to be homebound. However, many patients who require skilled home healthcare show periods of improvement where they have more mobility and are not strictly confined to their home. When this happens, patients are no longer eligible for the Medicare home health benefit. For some of these patients, the result is a vicious cycle of improvement, decline, and readmission to the hospital or emergency room.
Furthermore, the current home health benefit does not lend itself to coordinated care for patients. Traditional Medicare is structured in multiple, separate payment systems for different types of health professionals and providers (with separate payment systems for hospitals, physicians and home health agencies). These payment siloes provide little incentive to coordinate care and the result for patients is care that is fragmented and based on what Medicare pays for, not what patients need. There is a clear need for improved care coordination so that all healthcare professionals and providers are up to speed on what is happening with their patient, and duplicative or unnecessary treatments are avoided. Better care coordination is shown to improve patient outcomes, while simultaneously reducing unnecessary health care spending. For home health patients in particular, care coordination is critical because they often have multiple chronic conditions. According to the 2013 Home Health Chartbook, over 83% of Medicare home health users suffer from three or more chronic conditions, over 20% more than the Medicare population as a whole.
Finally, advances in technology – including telehealth tools used to monitor patient behaviors – also hold great promise for improving patient care in the home, yet the Medicare home health benefit does not currently support these innovative approaches to care. Successful home-based care programs, including the Veterans Affairs Home Base Primary Care (HBPC) program, utilize teleheath as needed to closely monitor its patients. Increased support for these tools will likely play a considerable role in the delivery of home health in the coming years.
Throughout the project, the Alliance will identify infrastructure, research, workforce, technology and policy needs to develop a strategic framework for the critical role home healthcare will play in the coming years. This framework will ensure seniors receive the best possible healthcare in the comfort of their own homes for generations to come.
I encourage health care professionals and issue experts across the health care continuum to take part in the Future of Home Health Project by sharing your perspective on the role of home health today and its promise for the future by participating in the FOHH events. More information on the project can be found on our web site and we welcome suggestions, comments, and ideas on the project to be emailed to the Alliance.
