Broader role envisioned for home healthcare

Home healthcare services will expand to include acute care, long-term care, technology-assisted care and primary care, according to a briefing commissioned by the U.S. Alliance for Home Health Quality and Innovation. Healthcare professionals will be able to share patient information readily, engage in teamwork and strengthen the continuum of patient care from hospital to home. Advocates also used the occasion to call for an end to the so-called 60-day rule; Sally Rodriguez, MPH of Alvere argued that there is a "consensus that that needs to be changed in some way to be able to deploy home healthcare in a way that makes more sense given the evolution in the healthcare system."

A much wider variety of healthcare services will be provided at home in the coming years, several speakers said at a briefing on the future of home healthcare.

"There will be an emerging continuum of care at home," said Steve Landers, MD, MPH, president and CEO of VNA Health Group, a home care agency in Red Bank, N.J. That continuum will include "acute care models at home, hospital-at-home concepts, urgent-care-at-home concepts, home-based long-term care, informal care, technology-supported caregiving at home, home-based primary medical care, and independence-at-home concepts."

Landers spoke Thursday at a briefing sponsored by the Alliance for Home Health Quality and Innovation, a group whose members include home health agencies as well as consulting firms and device companies. The alliance released findings from a four-part project on the future of home healthcare.

The project includes a report being developed by Avalere, a Washington-based healthcare consulting firm. The report, expected to be released later this year, will be based on literature reviews, interviews with policy leaders, interviews and case studies with innovative home health providers, and a review of the Institute of Medicine workshop on the future of home healthcare.

Home health agencies of the future will be "less and less independent per se" and instead, more connected through technology, said Landers, who is also vice-chair of the alliance. "Doctors, hospitals, and home health agencies will exchange patient information more seamlessly; [they will be] more connected in terms of teamwork and care planning; [and have] care plans that cross venues of care from the hospital to the home." He added that the agencies also will be more connected "through various business integration models, be they preferred provider relationships, network relationships, or true integration or joint ventures."

Home health agencies also will be used to help improve outcomes during care transitions; they will be technology-enabled "to document care and coordinate care using mobile and digital technologies ... with better use of analytics and data to help us make better decisions about the type of care people can get," Landers said. And in between visits, "technology will be filling the 'white space' between those encounters [with] educational resources, messaging, video conferencing, and other monitoring technologies."

In addition, home healthcare will be used to support home-based primary care and home-visiting primary care models, he said. "Primary care medical teams -- physicians and advance-practice nurses -- will encounter times in the care of patients where things aren't going well, when they're having an exacerbation of chronic conditions, when there's been a fall, when there has been a decline in function ... or a new type of medicine or equipment that requires extra nursing rehabilitation support. We envision the home health agency being that local hub or resource that can come in and provide episodic support to enable that ongoing primary care in the community."

Sally Rodriguez, MPH, a director at Avalere, said that thought leaders and policymakers interviewed for the project discussed the ways in which the payment structure was making it hard to support innovation in home healthcare. "They want providers to have empowerment to deliver care that fulfills the shared goals of high quality and low cost, but we're still operating in a fee-for-service world, so oftentimes there's not enough flexibility there to deploy the care at the right time for the right people."

Currently, Medicare has some strict rules for use of its home care benefit, she continued: "There's a 60-day episode [rule], and patients need to be homebound. ... There was a consensus that that needs to be changed in some way to be able to deploy home healthcare in a way that makes more sense given the evolution in the healthcare system. They agreed there may not be a lot of political will to do some of those things right now, so it may have to flow from providing flexibility further upstream to risk-bearing providers like health systems' accountable care organizations, and letting them provide more flexibility to the partners they have working downstream."

Some of the home health providers Avalere talked to for the report "are mixing services in different ways that are difficult to handle financially but are leading to some really great results," Rodriguez said. "But many things are not reimbursed via Medicare, so they have to be funded in different ways."

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