Trends and strategies for home-based care
With COVID-19 exposing the fragility of the healthcare system along with the growing desire to age in place, home is becoming the hub for care delivery. Pair that with the fact that the 65-and-older population is projected to surpass 80 million by 2050 (almost doubling the senior population from 2012), and it’s clear that the shift to home-based care is unlikely to slow down.
In the wake of a global pandemic, we’re seeing many trends and strategies for home-based care. These include:
- Streamlining regulatory and reimbursement policies to drive care to the home
- Complementing medical and non-medical care services for quality outcomes
- Shifting from traditional Medicare fee for service to Medicare Advantage plans
- Rebounding of occupancy for facilities and institutions affected by the pandemic
- Emerging care models that allow some skilled services to be provided in the home (e.g., complex wound care, intensive therapy, or certain unstable cardiac or pulmonary conditions) with a complement of clinical and non-clinical services
- Piloting of various programs by CMS, including the Hospital at Home program
- Stronger emphasis on risk-based contracts
Another trend we’re seeing is the emergence of quality provider networks in and out of hospital care. Hospitals, upstream referral sources, and ACOs are building networks of high-quality providers that can demonstrate their ability to provide better outcomes through quality measures and analytics. Referral networks are being narrowed down to providers that can drive optimal outcomes both economically and clinically. This “steering” of patient flow is something we expect to see more of.
While quality providers are being narrowed into networks, post-acute providers that have survived the challenges of COVID-19, as well as PDGM regulations, are adapting to their new normal by diversifying services. Some home health organizations are now offering home care or hospice services. Hospice organizations are breaking out of that six-month window by providing palliative care or personal care services. Skilled nursing organizations are partnering or providing home health. Diversification in post-acute is a major trend and will continue to contribute to care being driven to the home.
What are the implications of these trends and how can home health agencies ensure success as the industry evolves? Here, we’ll discuss these questions, along with strategies agencies should consider to stay ahead of these trends.
As acuity increases in the home, the number-one issue our customers face is the staffing shortage. With the number of unfulfilled caregiver jobs projected to be in the millions within the next five years, it’s more important than ever to evaluate the culture within your organization, the work-life balance you provide, and the technology that empowers caregivers at the point of care. Your workforce strategy should also include algorithms for matching caregivers to clients, pay, and benefits to help set you apart as an employer.
Your EHR and its ability to handle a range of care settings is critically important—especially when it comes to point of care in the home. Features like maintaining a unified patient record, optimizing schedules, integrating revenue cycle management, simplifying interoperability, and incorporating analytics should be must-haves for every home-based care organization.
Value-based reimbursement and MA plans
With value-based purchasing being rolled out for home health, Value-Based Insurance Design (VBID) testing out hospice services with MA plans, a shift from fee-for-service to MA plans, an acceleration of managed Medicaid, and more, it’s clear the industry is rife with change. Organizations need to focus on operations, workflows, and how they participate in risk-based contracts to sustain cash flow as the reimbursement process evolves.
Cash flow issues
As these industry changes continue, the organizations that optimize their revenue cycle management will accelerate their cash flow. Margins may vary based on services, payers, and other factors, and CMS could likely raise rates. That’s why having a clear understanding of the KPIs that need to be measured will set successful organizations apart from the rest.
Evolving with the industry
Whether brought on by a pandemic or an aging population, care delivery in the home was inevitable. Now that we’re seeing more trends and strategies for home-based care, it’s time organizations prioritize their operations to accommodate these industry demands to stay competitive and maximize cash flow.
Foresights and insights from these broad macro themes will serve providers well as they think about their near and mid-term strategies for home-based care. Tune in for part two of this blog series, which will cover the technology implications central to driving competitive advantage.