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Future of Home Health Care Framework Emphasizes Critical Roles of Home Health Agencies and The Need to Address Financing and Regulatory Challenges

June 30, 2016
Contact: Emily Adler

Future of Home Health Care Framework Emphasizes Critical Roles of Home Health Agencies and The Need to Address Financing and Regulatory Challenges

Preview of final report underscores need to better utilize home health care as part of the overall health care delivery system as the population ages

The Alliance for Home Health Quality and Innovation (the Alliance) today convened a panel to discuss the framework developed for the Future of Home Health Care (FOHH) Project based on research by Avalere Health. The framework highlights the need for policy-makers to address challenges to enable home health agencies to fulfill key roles that support the Triple Aim and the goals of new and alternative payment models as a means to allow for the appropriate use of the Medicare home health benefit in the years ahead. This will be critically important as the American population ages and lives longer with more acute and chronic conditions.

In three years, according to a report from the United Nations, people over age 65 will outnumber those under age five and increasing numbers of seniors will face significant functional impairments. As such, one of the country’s greatest health care challenges is ensuring that older Americans remain as independent as possible in the comfort and dignity of their homes and communities.

Medicare and other payers, who are increasingly turning towards alternative payment models (APMs), will need to make a strategic shift to making care in the home and community a priority in order to achieve the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per capita costs of health care.

“The FOHH framework, which is aligned with the goals and trends of value-based reform for the overall health care system, reflects the potential of home-based care to drive patient-centered, coordinated care at lower costs,” said Sally Rodriguez, Director at Avalere Health. “Medicare skilled home health agencies must maintain high standards of quality and develop collaborative capabilities in order to capture this opportunity to serve as a linchpin in the broader health care continuum.”

“As the health care system evolves, it is crucial that Medicare home health agencies evolve as key partners with risk-bearing entities and actively manage patient care,” said Teresa Lee, Executive Director of the Alliance. “In the long-term, key stakeholders hope to see home health agencies expand their role to formally accept risk under new payment models, allowing them to share in both savings and losses with care partners.”

In order to enable such partnerships, the FOHH framework lays out four key characteristics of the Medicare home health agency (HHA) of the future. These include providing care that is patient and person-centered, seamlessly connected and coordinated, high quality, and technology-enabled. This will allow HHAs to serve in three critical roles.

Home health agencies will:
- Provide post-acute care and acute care support;
- Partner with longitudinal, outpatient primary care medical homes and home-based primary care; and
- Partner with home-based long-term care and social support models.

“The home health agency of the future will not only play a critical role in post-acute care, but will also be seen as a key partner in helping patients achieve their highest level of health by providing skilled nursing and therapy in the home setting and in collaboration with primary care, home-based long term care providers, and caregivers,” said Steven Landers, MD, President and CEO of VNA Health Group and Vice-Chair of the Alliance Board of Directors. “Care in the home offers providers an enhanced view of patients and their caregivers, breaks down barriers to care and is a cost-effective model within the care continuum.”

However, significant challenges in the current landscape must be addressed to ensure Medicare home health can provide high quality care to its beneficiaries in the future. This calls for the Centers for Medicare & Medicaid Services (CMS) to allow the payment system to reimburse for services that are essential for integrating patient care, such as health information technology capabilities, telehealth, and staffing for care coordination and care transition support.

The report also recommends that in the context of new and alternative payment models, CMS should address financing and regulatory constraints that are barriers to the use of clinically appropriate and cost effective use of home health care to meet APM goals. This includes testing of the selective waiver of the current requirement that a beneficiary be homebound to receive the Medicare home health benefit.

Finally, the framework calls for targeted reforms in the home health care community to combat fraud and abuse through program integrity measures that focus on the well-known “hot spot” areas identified through aberrant claims patterns.

“The framework for the Future of Home Health project reflects a commitment to pursue changes in the way Medicare skilled home health care is delivered to a rapidly aging population,” added Kathleen Gilmartin, President and CEO of Interim HealthCare and Chair of the Alliance Board of Directors. “We stand ready to work toward fulfillment of the framework for the future of home health care using alternative models for the delivery of skilled home health care.”

The final report is pending publication and will be released later this year.