December #HomeHealthChat: Home and Community-Based Services

The December #HomeHealthChat was co-hosted by National Quality Forum (@NatQualityForum). The National Quality Forum leads national collaboration to improve health and healthcare quality through measurement.

The #HomeHealthChat focused on Home and Community-Based Services.

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 of Communications and Events Jen Schiller here.

Below are some of the highlights from the chat:

Alliance Partnering with VNAA to Improve Home Health Care for the Future

The Alliance is excited to announce a new collaborative partnership with the Visiting Nurse Associations of America (VNAA) focusing on aligning key quality improvement, education and research efforts in an effort to better support our members and the home health community writ large. Through better collaboration, the Alliance and VNAA will be able to focus collective efforts and resources on opportunities to improve care for patients and the health care system by appropriately optimizing home health care.

Both organizations’ staffs are looking forward to working together on a number of exciting events and initiatives in 2016 and beyond.

Below is additional information about the partnership, and some of the benefits for both organizations and the home health care community.

Who are the partners in this announcement?

The Alliance for Home Health Quality and Innovation (the Alliance) is a nonprofit, national consortium of nonprofit and proprietary home health care providers and organizations. The Alliance invests in research and education about home health care and its ability to deliver quality, cost-effective, patient-centered care across the care continuum. The Alliance is committed to conducting and sponsoring research and initiatives that demonstrate and enhance the value proposition that home health care has to offer patients and the entire U.S. health care system.

Visiting Nurse Associations of America (VNAA) is a nonprofit, national industry organization that supports, promotes, and advances mission-driven providers of community-based health care including home health, hospice, palliative care and health promotion services to ensure quality care within their communities. VNAA leads innovation and transformation for home-based care providers to ensure success in new health care delivery and payment models.


What is the purpose of this alignment?

The Alliance and VNAA seek to reduce fragmentation of industry leadership and resources to achieve long-term affiliation and alignment of programs and services for the benefit of the home-based care industry, the respective members of each organization, and for the public good.


Why is this alignment important for the home-based care industry?

The alignment of the Alliance and VNAA will significantly strengthen the voice of home based care providers in Washington and across the country. Aligning forces for purposes of research and education will strengthen the voice of home-based care providers, and allow for more efficient and more effective initiatives. This alignment will also allow VNAA and the Alliance to streamline resource allocations and strategic agendas to reduce duplication of efforts.


Why is this alignment important to policy makers?

Policymakers in Washington, DC have expressed concern about the fragmented voice of the home-based care industry. This alignment brings together two highly regarded home-based care member organizations to strengthen that voice and leadership for the industry. Collectively, VNAA and the Alliance represent a significant portion of the home-based care provided in the United States.


How is this alignment important to patients and family caregivers?

Strengthening the voice of home-based care providers will help ensure continued access to high quality home-based care services. Ensuring access to services will allow patients to stay in their homes and provide important support and education for family caregivers.


What impact will this alignment have on current members of VNAA and the Alliance?

Existing VNAA and Alliance member organizations will benefit from enhanced and expanded research agendas and materials, co-located meetings and symposia, as well as member-level access and pricing to both organizations’ events and materials. These enhanced benefits will be in addition to current member benefits provided by each organization.


What is the timeframe for this alignment?

The Alliance and VNAA have begun to work collaboratively on important initiatives, and will continue to identify new operational and programmatic opportunities in the coming months.


What types of projects are the Alliance and VNAA already working on?

VNAA and the Alliance have launched a collaboration to identify and promulgate best practices for home-based care services. Specifically, VNAA and the Alliance have invited leaders with appropriate expertise from each organization to participate in the workgroup on hip and knee joint replacement best practices in response to the Centers for Medicare and Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CCJR) demonstration program. This program will increase demand for high value hip and knee home care programs, and presents a significant opportunity for home-based care providers. The collaborative results will support and expand VNAA’s industry-leading best practice resource, The VNAA Blueprint for Excellence. The VNAA Blueprint tool and website includes evidence-based best practice information, along with training information, evaluation metrics, and additional resources.


What types of collaborative projects do the Alliance and VNAA anticipate in the future?

VNAA and Alliance members may consider research into the impact of interventions supported by best practices such as VNAA’s Blueprint for Excellence. Such research projects would align with VNAA’s research database initiative. In addition, where feasible, the Alliance and VNAA will plan joint meetings to align projects, press briefings, conferences and symposia to advance research and educational efforts on the value of home-based care in new health care delivery and payment models.


Will the Alliance and VNAA continue to operate as separate organizations?

VNAA and the Alliance will continue to operate as separate organizations. The leaders of both organizations will continue to seek further areas for collaboration and partnership.

CMS Continues Advancing Alternative Payment Models

Alternative models of payment are a trending topic for the Centers for Medicare and Medicaid (CMS) as the agency hits the half-century mark. Given that the Secretary of Health and Human Services has specified a goal of moving 50 percent of Medicare payments to alternative payment models within the next two years, the health care system—and home health care as part of it—lies at a critical juncture. It is more important than ever to understand these new models, and several recent publications shed critical light.

In the November 19th issue of The New England Journal of Medicine, Paul Ginsburg and Alice Rivlin explored the challenges facing CMS in a changing healthcare delivery environment (available here). Given CMS’s commitment to alternative payment models and quality care initiatives, the health care delivery landscape of the future appears to be approaching more quickly than ever, and Ginsburg and Rivlin see this as an opportunity to improve both quality and efficiency.

Though CMS has been clear about making bundled payment arrangements a high priority alternative payment model, there are multiple programs and approaches that are testing bundled payments. The Center for Medicare and Medicaid Innovation’s (CMMI) Bundled Payment for Care Improvement (BPCI) initiative. BPCI aims to change both the delivery and payment of health care services, and consists of four different models under which the initiative operates. Models 1 and 4 refer to inpatient acute care hospital stays alone, but models 2 and 3 include either inpatient stay plus post acute or post acute care only. Health Affairs recently issued their policy brief focused on BPCI and the opportunities, concerns, and early findings from the program. The full brief is available online here.

Although BPCI is still underway, the newly finalized Comprehensive Care for Joint Replacement (CJR) Model will quickly disseminate bundled payments across the country. Starting on April 1, 2016, hospitals in 67 geographic, or metropolitan statistical areas (MSAs), will be mandated to bundle payments for all traditional Medicare MS-DRG 469 and 470 cases. The episode begins with the admission to a participating hospital and includes the 90 days of care post-discharge for all services paid under Medicare Parts A and B, with limited exceptions. The final rule for the CJR Model is available in the Federal Register here. The CJR model does not apply to those already in BPCI Models 1, 2, or 4.

Bundled payment and other alternative models of payment provide unique challenges and opportunities for home health care. The focus on higher quality, lower cost care puts home health care in a critical place in the health care delivery system. In general, home health care is least costly and patient preferred in post-acute care, and therefore of increasingly recognized importance.

As the healthcare landscape, and especially Medicare, continues to reinvent itself and push toward alternative models of payment and delivery, providers, policymakers, and those at CMS must continue to work together to ensure that quality care is not sacrificed for cost-effectiveness, and that patient-centered care remains at the forefront of this mission.