Merrily Orsini's Thought Leadership

Part 1: The Healthcare Ecosystem – Survival and Collaboration

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.