Reinventing Home Care: From Transactional to Transformative

Published April 6, 2016

Our healthcare system is undergoing a fundamental transformation, moving from a supply-driven system structured around providers to a patient-driven system where establishing value is the principal goal. Traditionally, the interests of healthcare system stakeholders have not been aligned, resulting in fragmented, low-quality patient care undermined by growing costs and no focus on outcomes. In the face of these challenges, the healthcare system is making a proactive move to a more integrated framework: value-based healthcare delivery. This shift means moving from a legacy system that rewards volume of visits, hospitalizations, procedures and tests to a system that focuses on improving patient outcomes while lowering costs. Value is a solution that’s starting to unite the interests of all system participants, but it’s not going to be an easy road.

One of the bright spots in the value journey is home healthcare. Care in the home has the potential to improve patient outcomes in the least costly, and generally patient-preferred, setting. However, designed almost 50 years ago, home healthcare emphasizes recovery from acute illness and assumes that the patient’s health problems will end. And today’s home healthcare tends to focus on managing individual services, instead of what combination of services or staff specialty could result in better (or worse) outcomes.

In the healthcare industry’s quest for lower costs and higher quality, hospitals, providers and home health care players are piloting new outcomes-based care delivery models such as accountable care organizations (ACOs) and bundled payment arrangements. Home health care teams are natural partners in these models because their expertise can be leveraged to support some of the most costly patient needs across the continuum.

We here at CareCentrix, a leader in managing patient care to the home, identified the hospital to home transition as one of those costly needs. CareCentrix has a skilled network of health professionals ready and able to work closely with hospital staff, patients, their families and caregivers to facilitate the critical transition. For example, our care transition program with a 325,000 member health plan reduced readmissions 38 percent over three years, resulting in savings of over $50M. The value proposition of home healthcare now and in the future is strong, but that proposition alone is limited without research and analysis.

To this end, in CareCentrix’s view, the successful – reinvented – home health enterprise of the future will offer full-service coordination of post-acute care and will manage challenging populations with chronic, co-morbid conditions. They will integrate health technology by caring for patients in novel ways. They will deploy preventive technologies that keep patients safe and out of the hospital. They will align with ACOs, hospitals and health systems for bundled services and risk-based contracts based on patient type. And they will be fully accountable for the quality of care delivered and will put their payment at risk if quality suffers. The home healthcare sector must develop a sense of urgency to find the opportunities that drive their enterprises towards the successful home health enterprise of the future, and not get left in the past.