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Adapting To Healthcare’s New Payment Models: Value Versus Volume

Published by D Healthcare Daily
John Olajide
February 11, 2015

The emerging age of healthcare is a shift to payment reimbursements based on better value at an affordable cost, accountability for improved patient outcomes, and patient-focused care instead of the volume of services provided.

As part of the Affordable Care Act (ACA) of 2010, the U.S. Department of Health and Human Services (HHS) is rolling out new Medicare payment models based on the value patients receive from provider services. The new models pay for performance through financial incentives tied to quality measures and cost reduction.

While these programs have been rolling out over the last several years, HHS is stepping up the implementation. Last week, HHS Secretary Sylvia Burwell announced measurable goals and a timeline to transition Medicare, and the overall healthcare system, to paying providers based on performance.

The new goal is 30 percent of ‘traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.’ HHS also has a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016; and in 2018, that number jumps to 90 percent.

Technology will play a critical role in the success of these models. The importance of healthcare providers using technology—including mobile applications—will be necessary as the need for interoperable electronic health records—to share information among healthcare professionals—grows. The telemedicine industry has already set the stage for more accessible care. Remote patient monitoring offers continuous assessment from a convenient location.

The technology push was evident last month at the Alliance for Home Health Quality and Innovation (AHHQI) symposium held in Washington, D.C. as part of its Future of Home Health program. Experts discussed how technology will help the industry achieve seamless communication among federal, state, local agencies, and clinicians. The technology link was identified as the conduit for better care models, as well as cost-savings and helping streamline the process of patient claims, to name a few.

Esteemed speakers and panel members at the symposium, including Dr. Steven Landers, Chairman of the Alliance for Home Health Quality and Innovation (AHHQI) and President & CEO of VNA Health Group; Brian Griffin, President and CEO of Empire BlueCross BlueShield; Tracy Lustig, Senior Program Officer with the Institute of Medicine; Bruce Leff, Professor of Medicine at the Johns Hopkins University School of Medicine; and Sam Smith, Vice President of Business Development at Axxess. They each discussed the Triple Aim of healthcare, the impediments to healthcare IT adoption for home care adoption and the challenges of the home healthcare industry and its future.

Nearly everyone agreed that the solutions to areas in home health that need support lie in technology. While technology is playing a critical role in the home health field, the Medicare home health benefit does not currently support these innovative approaches to care.

Some states, however, are starting to reimburse for telemedicine under Medicaid; but this is merely scratching the surface. The benefits of tech in home healthcare extend deep into the industry. Creating standardization in quality measures across the board, as well as advancing interoperability of electronic medical records and electronic health records, will likely happen soon, but that is only the beginning of what technology can do.

The AHHQI is leading change by organizing a research-based strategic planning project for the future of home healthcare in America. In the future, these types of efforts are imperative to aligning home healthcare’s growth with the changes occurring in the U.S. healthcare system.

The home healthcare sector continues to see substantial growth due to the need for lower-cost alternatives to hospitals and nursing homes for the care of the aging baby-boomer population. In many ways, the benefits of the home care model compliment the current reforms being undertaken in the healthcare system and should lay the groundwork for improving the U.S. healthcare system for years to come.

At each step along the way, the home health model helps solve challenges such as moving from disease states to functionality and from frailty to mobility. With newer payment models, home health will play a key role in helping determine the level of care needed and who is at greatest risk for hospital re-admittance, ultimately reducing hospital readmissions.

But that is only the start. Mobile technology, for example, will pave the way for increased communication and collaboration within teams comprised of social workers, physicians, nurses, therapists and family/caregivers to plan care with the patient’s goals in mind. Emerging technology and new payment models are the cornerstones of an elevated national healthcare system.