Guest Commentary: A value-based case for collaboration to keep patients at home
Our healthcare delivery system is transforming faster than ever imagined, with organizations aggressively taking new approaches to improve patient outcomes and lower costs.

Our healthcare delivery system is transforming faster than ever imagined, with organizations aggressively taking new approaches to improve patient outcomes and lower costs. Value-based initiatives in particular are spreading farther and wider, with no sign of that trend changing.

Yet the healthcare delivery system is often too slow in introducing the innovations needed to get us where we all need to go. We need to embrace change, look for innovations and work together to achieve better quality and higher savings.

A case in point is the attitude toward healthcare being delivered at home. The concept of people aging in place is popular, and demand continues to grow. With Americans living longer and more patients suffering from chronic illness, services provided by the home health sector are often misunderstood, underused, undervalued and, as a direct consequence, overlooked.

Why the reluctance to follow a course that has demonstrated its value repeatedly over the decades? The answer is that under fee-for-service, providers and payers focused largely on episodic care, based on the acuity of a condition. Before the push to reward value over volume, no strong financial incentives existed to motivate healthcare organizations to think long-term and make sure care is continuous rather than piecemeal.

Providers, particularly physicians, hospitals and health systems, should take note of the advantages home health offers. Payers, ever on the lookout for efficiencies and synergies among healthcare players, also should recognize the benefits both clinically and financially. To cite one example, consider a 2016 study by UCLA researchers published in the February issue of the journal Medical Care: it found that patients who were referred to home healthcare following hospital discharge experienced better outcomes and incurred lower costs.

Demographics combined with strong consumer preference demand this shift to healthcare at home. According to HHS, 70% of people turning 65 can eventually expect to use some form of long-term care. No fewer than 90% of seniors say they want to stay at home as they age, not in an institutionalized setting, according to an AARP survey. With 85% of Medicare home health patients suffering from at least three chronic conditions, maintaining continuity as care moves from acute to chronic will be even more essential.

Compounding matters, the average length of a hospital stay is growing ever shorter. The rigors of discharge planning and transitions of care have assumed new complexity and importance.

Indeed, home healthcare increasingly pioneers new approaches to monitoring, managing and treating chronic illness. Clinicians ranging from nurses to therapists are leveraging point-of-care technology, implementing telehealth initiatives, and deploying predictive modeling and analytical capabilities to ensure high-quality care in the home. And we must continue to build on those capabilities.

At Amedisys, we recently rolled out new protocols for patients with heart failure and COPD. Those programs encourage patients to participate more in taking care of themselves, a key element in the home-health equation. Concurrently, we've broadened and deepened our efforts to train clinicians in the latest techniques and technologies. We're also developing analytical capabilities that enable us to predict the risk of re-hospitalizations. These programs and tools should help divert low-acuity hospitalizations, increase the home health option for sicker patients and be proactive with patients who we know have a high risk of bouncing back into institutions.

Only recently has Medicare introduced a system for rating home healthcare, with ratings of one to five stars assigned to care centers. These performance evaluations, made public for all to see, hold the industry strictly accountable for its work, all while keeping caregivers, families, providers and payers fully informed.

No individual or organization can go it alone in healthcare, and that's certainly true for the professionals delivering services directly to patients at home. Responsibilities are shared. Care needs to be coordinated to meet population health needs and the challenge of affordability. All the players that provide post-acute care–from health systems to health plans and accountable care organizations–need to forge strategic partnerships with home-care providers.

Let's come together sooner rather than later. Let's take on risks together, align incentives together, demonstrate creativity together and, above all, serve patients well together–and at home, where they most want to be.

Paul Kusserow is president and CEO of Amedisys, a national home health, hospice and personal care services provider.