Merrily Orsini's Thought Leadership

The (As of Yet) Uncharted Future of Home Centered Care

Home Centered Care

The Future is Home Centered Care

When it comes to home care, we should all be familiar now with the Triple Aim: improving patient outcomes, reducing cost of care and improving the health of our population. Accommodating this lofty goal, with the influence of federal policies (including the Medicare home health benefit), along with the sea of seniors —and the home health boat is rocking. It’s only a matter of time (we’re talking 10,000 new Medicare eligible adults each day) until something breaks.

The Future of Home Health Care Project, organized by the Alliance for Home Health Quality and Innovation, has been focusing the past year on these very issues—addressing how home health care is currently used, and how it will be used in the future for older adults. In another step along the way to finding answers, the ‘Future of Home Health Symposium: Tackling Critical Issues for the Future of Home and Community Based Care’ took place yesterday in Washington, D.C.

The day-long event was filled with panelists and speakers addressing issues in the industry—discussions ranged from optimizing home health interdisciplinary teams, to improving efficiency with technology, to key payment and policy reforms, to diverse interests and services funded in silos (which result in fragmented care based on what Medicare pays for, not necessarily what patients need), to the home health workforce. Much was covered, but the main unanswered question is, “What is the solution?”

Dr. Steven Landers chairs the Alliance and started the day with a Tom Peters quote: “If you are not confused, you are not paying attention”. And, anyone who has interfaced with the health care delivery system knows that is the case: confusion reigns supreme.

Technology is one possible answer for some of the issues. And, technology has been a game changer in the home health field; yet the Medicare home health benefit does not currently support these innovative approaches to care. Some states are starting to reimburse for telehealth in some home settings, but we have a long way to go.

As for the future of home health, there are many times when we feel like we’re are stuck in the ocean without an oar, and the waves are just bouncing us around. But with projects like the Alliance’s Future of Home Health Care Project and some of the new innovation projects sponsored by CMS, a collection of some of the top minds in home health care, the shore IS in sight—we just have to continue to communicate and encourage change.

At the end of the symposium, Steven Landers, MD, MPH, President and CEO of the Visiting Nurse Association Health Group, Inc. addressed the group and said we need to “work toward moving from our introspection and sharing to identifying basic tenets and themes to tell the world.”

And I agree. We need a better story up front, we (home care, home health care, home centered care) need to address who we are and what we need.

What are the core themes that are interdisciplinary? We need to identify those and agree upon a common set of themes and beliefs that we can tell the outside world to move forward. Key themes, common goals and critical next steps need to be identified for a future of home centered care that will meet the needs of an aging society.

From my perspective we could start with these core themes:

>Moving from disease states to functionality and frailty as keys to determining what level of care is needed and who is at greatest risk for rehospitalization

>Moving from post-acute care to a focus on wellness and preventing hospitalizations or falls in the first place

>Creating standardization in a) quality measures across the board, and b) interoperability of the EMR-HMR and home care/hospital/physician communication methods

>Developing a workforce that understands geriatrics and embraces patient centered care with the caregiver essential to the plan of care

>Developing specific interventions and protocols for those 5% of beneficiaries who absorb 50% of the cost of care

>Working as care teams with all looking at the patient with the patient’s goals in mind: social workers, physicians, nurses, therapists and family/caregivers

What core themes do you see?

We have a long way to go, the sea is endless and the water’s rough, but we are the leaders of our own vessels and I’m optimistic that we can steer home health care in the right direction.

AXXESS Technology Solutions needs to be applauded for their sponsorship of the Alliance and the Future of Home Health Care Project, along with their scholarships awarded for attendance to this symposium for state home care association directors, nursing doctoral students and industry consultants. It is businesses like AXXESS, stepping up to the plate and working to make the Triple Aim a reality, that will help make the home centered care dream for the future a reality.