Home Health & Home DME

Recovery and healing where patients want to be – at home.

The Challenge

Each stage of post-acute care is interconnected. Reducing costs in one area, without careful planning, can have unanticipated impact in another area. Reducing over-utilization of Skilled Nursing Facilities (SNFs), for example, must be augmented by carefully managed home care to result in lower readmissions. Many patients also require home health or DME in the course of ongoing treatment.

Connecting the silos that exist on a patient’s post-acute care journey requires an approach that integrates home health and home DME. Unfortunately, many plans don’t have the resources or ability to affect this approach.

man playing boardgames
  • Home Health expenditures are expected to grow to $157B by 20221

  • Demand for home DME is estimated to reach $43B by 20192

  • Waste and abuse is growing in these categories as well – estimated at $1.5B – $5B each year3

What is Home Health and DME?

After patients undergo treatment, surgical or otherwise, they will be discharged for post-acute care. This care may occur at a facility, such as a skilled nursing facility or long-term acute care facility, but, in many cases, it can be administered in the patient’s home instead. The goal of home health with home DME is to give patients access to trained professionals and resources they need to heal.

The CareCentrix Approach

CareCentrix provides scalable solutions for cost-effective, patient-centered Home Health & Home DME through a national provider network of over 8,000 locations.  Our program:

  • Uses a “home first when possible” methodology, supporting patients with the services they need to heal, and reducing risks attributed to institutional settings
  • Includes approximately 8,000 credentialed provider locations
  • Offers DME, home health services, home infusion nursing, and orthotics/prosthetics/supplies
  • Provides URAC- and NCQA-accredited utilization management and support through highly trained nurses and clinical teams
  • Reduces the risks and costs of fraud, waste, and abuse
  • Calls patients 24 hours after care was expected to start, validating that they receive the care they need
nurse with elderly patient

Benefits

  • Expertise and experience

    • Coordinated more than one million home health visits in 2016, and more than 4 million orders for home DME
  • On-time care

    • Start-of-care date is met more than 99% of the time
  • Care coordination

    • Patients leaving the hospital typically need between 3 to 4 services, often supported by different providers. We coordinate services and eliminate silos between these providers.
  • Reduces fraud, waste, and abuse

    • Estimates indicate up to 10% of current health plan spend may be detected as fraud, waste, or abuse

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Sources:

  1. Centers for Medicare and Medicaid Services, Office of the Actuary.
  2. http://www.harriswilliams.com/sites/default/files/industry_reports/DME%20Industry%20Update.pdf
  3. http://www.bio-medicine.org/medicine-technology-1/NICB-Report-On-Durable-Medical-Equipment-Fraud-30000-2/