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Dispatch From D.C.: An Increased Focus On Home And Palliative Care

Published by D Healthcare Daily
John Olajide
November 19, 2014

In September, Dallas-based Axxess, along with the Alliance for Home Health Quality and Innovation (AHHQI) and others, sponsored and participated in a workshop forum with the Institute of Medicine (IOM) and the National Research Council (NRC) on the current state of home-based services that address aging, disability, and independence.

The two-day workshop, held in Washington, D.C., served as a forum to examine how to best achieve the Triple Aim in healthcare: improving the patient experience, creating a healthier population, and reducing costs of care.

Representatives from institutions including Johns Hopkins, MIT, Cleveland Clinic and New York University joined business leaders and government policy makers in home health and long term supportive services to share ideas for the best ways to provide services to the growing number of older people – the estimated 55 million Americans aged 65 or older by 2020, according to the U.S. Department of Health & Human Services Administration on Aging.

The idea of ‘home centered care’ was a consistent theme of the presentations and discussion. The phrase, coined by Dr. Steven Landers, President of the Visiting Nurse Association Health Group and President and Chairman of the Alliance for Home Health Quality and Innovation, represents one suggested model for the future. It centers on the home care agency as critical to creating true person-centered care.

Instead of thinking of acute care as the starting point for providing care, the care starts before an acute episode, and it can start at home. Moreover, most care can be centered in the home. Hospitalization is a last resort, not a starting point.

Because the current care model as created and reimbursed by Medicare is specifically for Post-Acute Care (PAC), it does not meet the needs of a society that is aging rapidly and has multiple chronic conditions. Home-centered care is a model that integrates both primary care (physicians and APRNs), palliative care and end-of-life care.

The focus is on care coordination and management of care as well as care transitions. There are still nurses, therapists and home health aides involved, but there are also other social elements to be considered: housing, social support available and ability to pay for some of the care. The patient and the caregiver are included in the care planning, and there is an emphasis on proactive, preventive care.

The current healthcare delivery system was created in silos. Hospitals, home-based services, social services and physician specialties have been working separately instead of working together, communicating, coordinating and integrating the care needed. Home-centered care would move not only toward taking care of the patient in the home, but also toward more closely working together towards common goals.

Payment and reimbursement are obviously important to the success of any changing model, and several key policy approaches were identified. For instance, instead of using only disease states to reimburse care service providers, patient functionality or functional status could be considered. Bundling of payments to support functional needs and more flexibility and creativity in the delivery of care could be allowed. Additionally, the idea of value-based purchasing is another option for reimbursement that is working in some experimental models.

We have seen The Future of Home Health, which formally launched in May 2014, already gain traction in the healthcare community. The recent IOM workshop, as well as future workshops, will hopefully provide a strategic framework to accomplish the Triple Aim and better meeting the needs of those who wish to remain at home while aging or living with disabilities. At Axxess, we are excited to see how the next chapter unfolds.

John Olajide is founder and CEO of Axxess, a leading healthcare software company that provides cloud-based software to the home healthcare industry.