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    Oct 30 2014

    Eric Dishman from Intel Offers Insight into the Future of Home Health

    Posted by Merrily Orsini

    Future of Home Health

    Future of Home Health

    Rarely has one speaker had such a command of the past, the current and the future possibilities for home centered care. Eric Dishman has lived with health and caregiving issues most of his life, but he has overcome extreme obstacles and remained true to a quest to make the healthcare delivery system better for all. His tireless work in developing telehealth solutions that help the caregiver, the patient and society have made his a powerful force in charting the course for the future of home health. Please take the time to check out this video recording of the Institute of Medicine workshop on the future of home health, and visit the IOM website for more video recordings of the 2 day event held earlier this fall in Washington, DC.

    View Eric Dishman for Intel as he opens up day two of the IOM workshop.

    All presentations were noteworthy, but his one by Dr. Steven Landers’ presentation is especially pertinent and impactful.

    To view all the presentations, go to the IOM website and go to the upper right hand corner, and click “Other Meetings”.

    There is much more to come, and much to do as we, as a nation, work on how we are going to provide efficient, effective care to this burgeoning boomer population. We, at corecubed, are excited to be included in this wonderful process, and hope to continue to be at the forefront of changes that are occurring to achieve the goal of the triple aim: a healthier population, more efficient allocation of healthcare resources, and better patient experiences.

    Oct 27 2014

    Part 3: Shifting Perspectives and Steps Toward Lasting Change

    Posted by Merrily Orsini

    home care perspectiveInsights from the Future of Home Health Care: IOM-NRC Forum on Aging, Disability and Independence Workshop

    (Written by Merrily Orsini. Reposted with permission from Axxess.)

    It makes perfect sense that looking at something from a different angle makes you see it in a different way. And, when you see something in another way, you think and act in new ways. This type of perspective shift is required to produce real, lasting change.

    In his closing comments recapping the two-day workshop on the future of home health care, George Taler, MD, said: “Stop thinking of us (in-home care providers) as small fish in a large pond; and start thinking of us as the oxygen in the tank.” Now there’s a perspective shift. Air is a necessity, and in today’s evolving health care environment, home care is as well. In-home care is possible, attainable and preferred by most people. In fact, a high percentage of people, when surveyed, select care at home as the preferred option.

    So, if this industry is the air that healthcare needs to survive and thrive, what are the possibilities for the future and how can we get there? The first step is to identify societal needs and put great minds to work at a national policy level on emerging issues. As part of funding the Future of Home Health Study, Axxess facilitated an important first step by sponsoring this gathering of diverse interests to discuss ways to solve high-level healthcare delivery issues. Policy changes when momentum reaches a critical point; and thought processes in health care circles are starting to shift toward long-term support at home.

    Technology will continue to play an increasingly crucial role in the future of the healthcare delivery system. First, technology harnesses the power of the entire care team, including the patient, to communicate and share data. Technology helps monitor and manage patients in more efficient and cost-effective ways, as is the case with telehealth. Headway is being made toward the adoption of interoperability standards so systems can “talk” to one another. While licensure varies from state to state, and presents a barrier to some technology usage, just getting this item on the list and looking at ways to solve this issue, is another important step.

    As we start to think about health care delivery in a different way, we will start to educate future “deliverers” in different ways. Perhaps we will add inter-professional care as a component to educating health care workers with an emphasis on in-home care. The scarcity of workers to provide the care needed as the population ages is an issue not easily addressed. However, we can start by offering better training for today’s workforce; and continue to look at ways that technology can help meet care needs when a person’s physical presence is not necessary.

    It will also be necessary to adopt a common language in order to communicate feedback and care plans in a meaningful way to patients and other care providers. At its most basic level, “frailty” must have a common definition. Along with thinking of frailty as a determinant for care, comes a focus on function instead of just a disease state. Adding in exercise and wellness as a prescription given to people who need care, or who are predisposed to chronic diseases due to lifestyle, is one way to get society moving and eating better so we are all involved in the health of our population.

    There are many current innovative projects and payment model options, and a growing recognition that payment models must change so that value and quality are the key to reimbursement, not just episodes or visits.  We are seeing more responsibilities being allowed to the nurse practitioners, and that responsibility needs to expand so there is not a bottleneck caused by physician shortages. Lastly, moving to true coordination of care is desperately needed. We must change thinking to the concept that the home is a place to be healthy and safe; and allow health care to be delivered there efficiently and effectively.

    Home-centered care can be the “oxygen in the tank” for our future; but we must all be willing to give up some turf, look at how to better accomplish what we are currently providing, and be open to change. Change is upon us in the home health world, and more is to come. Let us be masters of our fate to help decide how best to solve the complex issues surrounding the services we provide daily.

    To see the presentations from this two-day workshop, log onto the IOM site.

    Oct 23 2014

    Part 2: Healthcare Recovery: How Can We Ensure a Better Future?

    Posted by Merrily Orsini

    Bright future ahead for healthcareInsights from the Future of Home Health Care: IOM-NRC Forum on Aging, Disability and Independence Workshop

    (Written by Merrily Orsini. Reposted with permission from Axxess.)

    The first step in any recovery program is to admit that you have a problem. The health care system is no different. It has to admit it has a problem in order to recover. So, here is the problem: Medicare was designed to help pay for health care costs for the elderly. Currently, and since its inception, Medicare has focused on reimbursing costs incurred when an older adult utilizes the services for post-acute care. Those services are not only expensive, but designed to be short-term solutions, and in the case of nursing homes, not where older adults want to be. They would rather be at home.

    That doesn’t mean post-acute care needs to go away. In fact, the need for short-term post-acute care will remain. However, America’s aging care issues are much different today than when Medicare was conceived. Adults now become “seniors” at the age of 55 and stay “seniors” well into their nineties and beyond. This new longevity brings with it a number of chronic health conditions that will require management over time – not in a post-acute care setting where an older adult will quickly exhaust all of his or her resources, but in an older adult’s home through the use of home care.

    And, what about the money that is being thrown at the problem? Did you know that Medicare and Medicaid are second only to the national defense in spending? If so, you realize that we are on an unprecedented spending trajectory that is unsustainable.

    When we look at the future of healthcare through this lens, it is clear that the problems are how we created our health care delivery system and how we have failed to advance it – until now. Instead of skirting the issue, both providers and consumers are beginning to take a stand, take action, and search for solutions. Axxess has funded a study through the Alliance for Home Health Quality and Innovation (AHHQI) that was instrumental in creating the platform for the hearings on the future of home health held September 30 and October 1 at the Keck Center in Washington, DC, and convened by the Institute of Medicine and the National Research Council.

    It is this type of support that will make the difference for the future; because in order to solve a problem, you first have to admit and understand the problem you have. You also need to understand where you are in the continuum of problem to solution; and then take the necessary steps to correct the problem or start over. You then need to measure, evaluate and repeat.

    CMS has been awarding grants for innovative projects. The Veterans Administration has been using telehealth, among other focused coordinated services, to serve the five percent of the population using most of the resources. Barbara McCann, from Interim Healthcare, phrases the issues clearly: “Medicare is an acute illness benefit in a chronic care world.” The main question most people ask when they become frail is: “Can I live in my habitat longer?” Care transitions are not just for a post-acute setting; rather, there are care transitions at each touch point in receiving care in the health care delivery system; and ensuring proper care for the elderly or chronic disease patients at home can reduce costly transitions and rehospitalizations.

    Steven Landers, an MD and MPH who currently works for the VNAA Health Group and is President of the Alliance for Home Health Quality and Innovation (AHHQI), has some ideas for how to better address the long-term needs of our population. He feels that home care can cost less, is more desired and is safer. He also says that it can be vibrant and impactful. His ideas are to create home-centered health strategies and focus on home-centered care that will reduce undue suffering and eliminate undue spending.

    As stated in Dr. Landers’ presentation, “In building the future, let’s not forget some of the basic, common sense advantages of home care that are as true today as they were when Lillian Wald and her colleagues from the house on Henry Street ventured out into the squalor of the lower east side of New York City at the end of the 19th century. When we take care of patients at home, there’s an enhanced view of patients and caregivers that leads to a better understanding of important issues like how they manage medications and nutrition. Home visits are an access intervention that is most relevant to patients with physical and socioeconomic barriers to care. During home visits, a more intimate, clinician-patient relationship can be established. Home care clinicians sit beside their patients in their bedrooms and at their kitchen tables. The home visit is an act of humility that demonstrates to the patient the clinician has left their comfort zone to be on their turf, that they are worth being truly known and visited. Home care can cost less while being desired more by many patients, and care at home is sometimes safer for frail elders.”

    Dr. Landers says there are four main clinical ingredients for the future:

    • Physician and advanced practice nurse developed and overseen interdisciplinary home health care plans; plans informed by the well-proven concepts of holistic geriatric medicine, palliative medicine and rehabilitation medicine assessment.
    • Enhanced support around care transitions; support that addresses self-management, care coordination, information transfer and clinical stabilization.
    • Advanced capability for escalating intensity of medical care and palliative care at home in times of decline or exacerbation (including escalation to hospital-like services at home).
    • The thoughtful use of advanced information technology to fill the white space between encounters, to aid in the management of unscheduled home care patient problems, and to improve triage and the overall efficiency of care.

    Histories are often fraught with mistakes and missteps, which seem troublesome and even overwhelming at the time. It is, however, past mistakes that can serve as meaningful lessons in how to improve the future. The history of health care delivery is no different; our past issues or shortcomings can help us pave the way to a brighter, safer and healthier future, with more care centered in the home.

    Oct 21 2014

    Part 1: The Healthcare Ecosystem – Survival and Collaboration

    Posted by Merrily Orsini

    ecosystem of healthcareInsights from the Future of Home Health: IOM-NRC Forum on Aging, Disability and Independence Workshop

    (Written by Merrily Orsini. Reposted with permission from Axxess.)

    Ecosystems work together so that all members can survive, change and grow, in accordance with the availability of resources to foster growth. Health care is also like an ecosystem, with different but crucial members that require collaboration for survival and growth. How does this apply to home health?

    According to the Centers for Medicare and Medicaid Services (CMS), annually, Medicare accounts for $572.5 billion of health care costs, and Medicaid for $421.2 billion. Yet, the home health care portion of that expenditure is only 6-7 percent. Historically, Medicare and Medicaid have reimbursed more for managing care in facility-based settings, such as hospitals and nursing homes, instead of home-based care. Nearly 50 percent of that current, enormous national expenditure is for the 5 percent of citizens who are considered “frail” and have multiple chronic health issues. The Organization for Economic Co-operation and Development’s (OECD’s) 2009 health data report shows that, compared to the other industrialized nations, the U.S.’s expenditure per capita is far greater, yet our quality of care is less. Now more than ever, it is time to revamp, refocus and revise so that the burgeoning baby boomer generation will have access to care in the home that our system can both afford to provide and deploy in cost-effective ways that assure better outcomes and provide greater value.

    A recent two-day workshop held in Washington, DC, at the Keck Center by the Institute of Medicine and the National Research Council is the first meeting to take place at a national policy level on the future of home health – the part of the health care ecosystem that all should focus on with greater urgency. Presenters revealed a wide range of options to be considered as possible ways to move home health to the center of the conversation with the goal of assisting the nation with caring for its own aging and disabled population, so that they can remain independent for as long as possible, and live safely and securely in a place that the vast majority want to be – at home.

    So, what are the key issues? What is our vision for the future of home care? How do we ensure the survival and growth of the home care industry? There are certainly multiple issues, and right now they’re all a component of the current ecosystem of healthcare: workforce, payments, technology and integration between components of the health care delivery system. Two of those components that are currently missing from the equation – and should be at the center – are the patient and the caregiver.

    What is the current spectrum of home-based care? At 6-7 percent of current expenditures, the reimbursement for care in the home is not in line with the desire for that service. The unintended consequences of a reimbursement system that is focused on post-acute care has created an imbalance in service delivery. The creation of specialties within the health care delivery system has also assisted in this silo of services. The patient, who should be at the center, is somewhere in the process, but not in a way that considers the whole of the patient and the entirety of the situation.

    The goal of delivering quality health care services should focus on the patient, his or her goals and helping caregivers who assist patients with meeting goals – integrated with the patient at the center. Resources should be allocated with the patient in mind, and the patient’s wishes included in the process. See a theme emerging here? To fix the system, we really have to start over and think of ways to work together, ways to pay for value and not quantity, ways to listen to the patient and his or her family, ways to communicate with each other so that we are all working together to solve the same problem: providing a supportive and coordinated system of care for those in need of care, but in a way that starts with where they are and meets their needs best.