Leveraging technology to provide better HLTH care

Healthcare and technology intersect daily, forming a portion of both the foundation of care provided to patients and the methods of delivery for providers. It’s therefore only logical that the two should engage in high-level conversation. Last month, the Alliance was proud to join the new HLTH conference as an Association Partner. In its inaugural year, HLTH brought together over 3500 attendees from across healthcare and tech for a three-day discussion with payers, providers, government, non-profits, and more on ways to innovate healthcare delivery in a changing landscape.

Home health care, particularly, offers a unique opportunity for tech to engage with healthcare delivery at a personal level. Providing care in the home is a deeply intimate act which requires providers respect patient’s homes and work within a different environment. Tech providers looking to further help the patient experience may find home health care providers a particularly well-positioned ally.

HLTH attendees got the chance to hear from CareCentrix CEO John Driscoll, who discussed how he believes risk-based models will help drive incentives to invest in home health and home and community-based services. Former Acting Administrator for the Centers for Medicare & Medicaid Services (CMS) Andy Slavitt also spoke of a need to invest in greater healthcare innovation for vulnerable populations such as the frail elderly.

While this was a good start, there is room for growth in the conversation. We know home health care is already leveraging technology, especially telehealth, to improve patient care; and we know that the needs of an aging population must be addressed, and that tech can help.

Over the last few years, AARP created the Tech Nest and Hatchery. The Nest, housed at the University of Illinois is a technology lab, which, according to Jose Hernandez, vice president of IT business operations at AARP, “Affords us an opportunity to marry up leading-edge technology and apply that to our social mission to disrupt aging, and allow folks to live independently and with dignity as they age.”

Meanwhile, the Hatchery housed in the Nation’s Capital, serves as a startup incubator for those looking to improve aging and connect with peers in the space.

Other examples of leveraging technology to improve care for aging populations are abound, and we know from “The Future of Home Health Care: A Strategic Framework for Optimizing Value” that the home health care delivery system of the future must be technology-enabled. This will require commitment on the part of agencies, collaboration from technology providers, and policy levers that incentive smart adoption.

Opportunity is ripe for even more innovation in technology that assists in the care of patients in their homes and communities, and the Alliance is excited to continue engaging our peers to find ways to improve patient care and experience.

CMS introduces new Pre-Claim Review Demonstration proposal

Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced a request for public comment on a new Pre-Claim Review Demonstration proposal. The new demonstration proposal offers home health agencies in the five proposed demonstration states three different options for payment. Under the new proposal, agencies can choose either potential full payment with pre-claim or postpayment reviews, or agencies can choose to forego the review process altogether with a 25 percent reduction in payments on all home health claims submitted. Agencies that choose the third option and payment reduction may still be eligible for review by Recovery Audit Contractors (RACs). The unpublished memo is currently available here, while the published version will appear on Thursday, May 31st in the Federal Register here.

The five states included in the new proposal are: Illinois, Ohio, North Carolina, Florida, and Texas. Ohio and North Carolina are new additions to the current proposal, replacing Massachusetts and Michigan in the original demonstration. The original demonstration did begin in Illinois in 2016 but was paused on April 1, 2017 and never re-started. At the time, CMS provided a brief Q&A on the pause here.

As in the past, the Alliance will be working with our membership as well as colleagues across the industry, to formulate a comment letter to CMS. You can read the Alliance’s comments to the Office of Management and Budget (OMB) from 2016 on the original PCRD proposal here. In those comments, the Alliance highlighted concerns related to the burden on home health agencies, process consideration, and legal authority.

CMS is said to be providing further updates this week so stay tuned for more information.

Alliance members interested in joining the discussion on PCRD and other regulatory and legislative efforts, as well as clinical and quality improvement should reach out to the Alliance’s Director, Policy Communications & Research, Jen Schiller at jschiller@ahhqi.org, to join the Alliance’s monthly Quality & Innovation Work Group.

Recognizing Mental Health Awareness Month at Home

Mental health awareness is critical in the delivery of health care at home. More than one in four home health care patients has a form of severe mental illness (SMI), defined by the Centers for Medicare and Medicaid Services (CMS) as having depression or other mental disorder, including bipolar disorder, schizophrenia, and other psychoses.

It can be easy to overlook the mental health of patients at times, especially given over 85 percent of Medicare home health patients have three or more chronic conditions and nearly one in three struggle with at least two different activities of daily living such as eating, dressing, or bathing.

Accounts of patients who receive mental health care through home health are few and far between, but their stories are reflective of so many others. Take for instance the story of Jane Early, BSN, who profiled a day on the life of a mental home health care nurse in the November/December 2017 edition of Home Healthcare Now. Early describes one patient with schizophrenia she had a number of years ago who was receiving in-home care following a hip replacement surgery. The first step was to visit the patient’s mental health clinic and then to do an assessment of the patient’s environment. Although the patient’s husband also faced mental health issues he was able and willing to be a support person, and the couple had extended family that was able to help address the environmental challenges in the home. Concluding her piece, Early declares, “When mental illness is part of the assessment, the importance of communication and education cannot be overstated.”

A few years back, the Alliance profiled Mr. John Cross, a Vietnam veteran receiving in-home care at an assisted care facility, who suffered from schizoaffective disorder. Mr. Cross was receiving home health care following an acute psychiatric hospital stay and the therapy interventions, which included occupational therapy, psychiatric nursing, and caregiver education, helped to manage some of the symptoms of schizoaffective disorder, including depressed episodes, periods of manic behavior, and impaired occupational function. Along with the help of the staff at the care home in which he was living, Mr. Cross’s sister was also an active provider of care for her brother. The program manager in Mr. Cross’s case echoed Early’s statements about the need for relationship building with the patient and support team.

Perhaps the most important takeaway from the profiles of mental health patients is the message that while patients with mental illness have unique needs, they’re ultimately no different than any other patient. In the Alliance profile above, Elizabeth Gregory, RN, CNS, PhD, Director of Behavioral Health at Amedisys, noted her concerns about inaccurate portrayals of mental illness, including the perception of a highly violent population. She clarified that these perceptions are untrue, and violent behavior is no more likely in the mental health population than in the general population. She stressed that patients with mental and behavioral health diagnoses are deserving of the same dignity and care as their peers.

As we begin to wind down Mental Health Awareness Month we hope to shine a light on of the work being done by home health care to address the particular needs of patients with mental illness. But they can’t do it alone. As both stories tell us, a patient’s additional support system, be it family and/or other caregivers, is a vital piece of the puzzle, especially when treating patients with mental illness.

We thank the providers and caregivers helping to care for patients with mental illness at home.

February #HomeHealthChat: How to work together in the home to improve cardiac outcomes

The February #HomeHealthChat was co-hosted by VNA Health Group (@VNAHealthGroup).

The #HomeHealthChat focused on how to work together in the home to improve cardiac outcomes.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director, Policy Communications & Research Jen Schiller here.

Below are some of the highlights from the chat:

Guest Blog: An Adapted Cardiac Rehabilitation Program for the Home Care Setting

Cardiovascular disease (CVD) remains the leading cause of death in the United States. Due to significant advances in health care, there is an increase in the number of individuals living with CVD. These individuals may struggle with self-management and symptom control, and 25% patients with heart failure discharged from the hospital are readmitted within 30 days. CVD is a particularly diagnosis common among the home care population, with heart failure (HF) and acute myocardial infarction/ischemic heart disease as leading conditions. Home care clinicians are often the first line of rehabilitation and support for patients post-hospitalization. An adapted home-based cardiac rehabilitation (CR) represents a promising approach to improving care and reducing hospital readmissions among patients with CVD. The services of CR can reduce all-cause mortality and cardiac mortality rates, and benefit patients through exercise and modifications of controllable risk factors. Despite the clinical effectiveness of CR, participation rates in these programs remain low. There is a need for alternate models of secondary preventative cardiac care to increase adherence to CR services and prevent poor outcomes. Home-based programs are potentially an effective and low-cost method of care. However, there are limited evidence-based evaluations that home care agencies are implementing the core competencies of CR programs into their episodes of care and that home care clinicians receive education on these competencies.

Our pilot program, Home Heart Health, is an adapted CR program for the home care setting. Home Heart Health is an interdisciplinary CR program that emphasizes CVD risk factor modification and management for home care patients. In our program, home care registered nurses, physical therapists, and occupational therapists were educated to provide adapted CR services to patients as a complement to traditional home care. This training for home care clinicians was adapted from the American Association of Cardiovascular and Pulmonary Rehabilitation professional core competencies for outpatient CR. It was developed based on literature and guideline reviews, as well as themes identified among patients and clinicians. During the program, patients received visits from these home care clinicians, who provided an exercise plan, nutrition counseling, and self- management education, with accompanying patient teaching tools. Clinicians practiced in accordance with standardized interventions checklists. We conducted a multi-phase study to develop, implement and evaluate this adapted CR program.

The first phase of the pilot was to develop and implement the CR training program adapted for home care clinicians, incorporating the viewpoints of homebound patients with cardiovascular disease. Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semi-structured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. A questionnaire was administered to home care nurses and rehabilitation therapists and compared for pre- and post-training. Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers’ importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge post-training compared with pre-training among home care clinicians. There was no significant difference between scores for nurses and rehabilitation therapists, indicating the feasibility of interdisciplinary training. As a result of this study, we concluded that home care clinicians respond well to an adapted CR training to improve care for homebound
patients with cardiovascular disease. Clinicians who participated in the Home Heart Health
training demonstrated an increase in their knowledge and skills of the core competencies for CR. Read the full manuscript depicting the development and implementation of the Home Heart Health program and training for clinicians here.

The second phase of the pilot was to conduct a mixed methods analysis to determine the
feasibility and acceptability of Home Heart Health. Surveys measuring patient self-care and
knowledge were administered to patients at baseline and at 30-day follow-up. Semi-structured interviews were conducted with patients and home care clinicians at completion of the program. All survey indicators demonstrated a trend towards improvement, with a statistically significant increase in the self-care management subscale. Qualitative analyses identified three patient themes: (1) self-awareness; (2) nutrition; and (3) motivation; and three clinician themes: (1) systematic approach; (2) motivation; and (3) patient selection process. We concluded that incorporating CR into the home care setting proved to be a feasible and acceptable approach to increasing access to CR services among elderly patients. As acute care transitions to the home and outpatient settings, coupled with efforts to meet patients were they are, studies demonstrating the feasibility of alternative methods to care are vital. Our pilot study supports the need for further testing with a larger sample to determine the efficacy of adapted cardiac rehabilitation for the home care setting. Read the full manuscript examining the feasibility andacceptability of Home Heart Health here.

Please contact Jodi.feinberg@homehearthealth.org with questions or comments!

November #HomeHealthChat: Physical Therapy in the Home

The November #HomeHealthChat was co-hosted by the APTA Home Health Section.

The #HomeHealthChat focused on physical therapy in the home.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director, Policy Communications & Research Jen Schiller here.

Below are some of the highlights from the chat:

October #HomeHealthChat: Health Information Exchange in Home Health

The October #HomeHealthChat was co-hosted by the Massachusetts eHealth Collaborative (@MAeHC_org) and Home Healthcare Hospice & Community Services (HCS).

The #HomeHealthChat focused on implementing and integrating health information exchange in home health transitions of care settings.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director, Policy Communications & Research Jen Schiller here.

Below are some of the highlights from the chat:

June #HomeHealthChat: Patient Refusals of Home Health Care

The June #HomeHealthChat was co-hosted by the United Hospital Fund (@UnitedHospFund).

The #HomeHealthChat focused on patient refusals of home health care. The conversation stemmed from the Aliance and United Hospital Fund co-sponsored roundtable report, released in May 2017. You can read the full report here.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director, Policy Communications & Research Jen Schiller here.

Below are some of the highlights from the chat:

April #HomeHealthChat: Home Health’s Role in Caring for People with Alzheimers and Dementia

The April #HomeHealthChat was co-hosted by the LEAD Coalition (@LEAD_Coalition).

The #HomeHealthChat focused on home health’s role in caring for people with Alzheimer’s and dementia.

The Alliance hosts a home health-focused Twitter chat on the fourth Tuesday of every month at 2 pm ET. Be sure to check here for updates on topics, co-hosts, and questions!

If you have topic ideas for future Twitter chats, or are interested in co-hosting a chat, please contact the Alliance’s Director, Policy Communications & Research Jen Schiller here.

Below are some of the highlights from the chat:

What’s in A Star Rating?

Co-authored by the Alliance and Visiting Nurse Associations of America

Over the past few months, the Centers for Medicare and Medicaid Services’ (CMS) introduction of patient experience survey star ratings to Home Health Compare, as a way to better understand the overall patient experience with care provided through Medicare-certified home health agencies, has gained a lot media attention.

While the jury is still out on the star ratings as a whole, home health agencies recognize that both quality of care and patient experience are critical. Agencies are learning from the issuance of the star ratings and are committed to improving their performance on both quality of care and patient experience.

Outlined below, the Alliance and VNAA breakdown the top five takeaways from the Patient Survey Star Ratings:

  1. The new patient survey star ratings do not replace, but instead are in addition to, the Quality of Patient Care Star Ratings used to describe the quality of clinical care provided by a Medicare-certified home health agency.
  2. Health care is moving towards a system that rewards value over volume and more readily engages consumers; as such, performance data will become increasingly important.
  3. The Home Health Compare Star Ratings are the first step towards streamlining communication regarding home health quality and patient experience in a way that is digestible to health care consumers.
  4. The discrepancies in the patient and quality ratings among individual agencies stem from several factors, including the limitation of the Medicare home health benefit, as well as the understanding of skilled versus non-skilled home health health services. For example, Medicare home health care provides skilled, clinical care, not services such as meal planning and house cleaning. Unfortunately, there is a disconnect for many patients when those needed non-clinical services are not met by their home health care team, despite receiving excellent clinical care.
  5. The patient experience survey is a positive step in the right direction, and is essential to capturing the overall home health care experience, but CMS must refine its metrics to capture more accurate data.

As organizations committed to advancing home health care, the Alliance and VNAA stand ready to work with the Administration to perfect the use of patient survey data so that it is balanced with necessary quality data.