Merrily Orsini's Thought Leadership

Right Now the Future of Home Health is Happening Around Us

The future of home care is now, and although painful, is necessary.

Change may be painful, but only lasting if not fully accepted.

Just witnessed what VNAA Executive Director Tracey Moorhead called “a morning of shock and awe” as the opening session of the VNAA Annual conference at the Roosevelt Hotel in New Orleans. However, the pre-conference session on population health management was a great primer for the information presented today.

Most of this information is not new to me, as I have been keeping abreast of the changes in the home care industry as well as in the larger health care delivery system for about 34 years now. And, with a healthy start in my career in the technology sector, I am not uncomfortable with technology, nor do I underestimate the power it has to change systems.

However, what was new this morning here at the VNAA meeting was the extent and the scope of the changes that are already in place. An overview of the latest research on consumer comfort with technology as a means of communicating to their clinician, and the clinician’s comfort with using technology was an eye opener. Ceci Connolly, Managing Director PriceWaterhouseCoopers presented some statistics that they are discovering through research. I am certain you have heard me rant about the obsolete and antiquated and archaic mindset of many of our nation’s physicians, but to see that patients, regardless of age, are really more comfortable than our physicians in communicating with easy devices that make everyone’s lives easier, was amazing.

And, to learn that hospitals are the #3 cause of death in America was also a shocker. In the home health care arena, preventing readmissions is the latest directive, but, according to the opening speakers, most notably Dr. Matt Blatt the Worldwide Medical Director at Intel, preventing admissions is even a more noble cause.

You see, the percentage of Medicare dollars that go to home care is around 4% of total spend, so to quote Jim Pyles, the champion of the Independence at Home Model of care, and principal Pyles, Powers, Sutter & Verville PSC, that is barely enough money to constitute a rounding error. So, why not look for cutting costs where most of the money is spent and that is hospitals. After all, have you ever met anyone who wanted to GO to a hospital?

Nancy Gagliano, Medical Director for CVS’s MinuteClinic, came out of Mass General to change care to allow patients to access care when they needed it and at a location close to home or wherever they were. Most of their patients are seen nights and weekends, and 85% of them do not have primary care physicians, so they are getting health care that they otherwise would not have gotten. And, the clinics are referring INTO the system, so the PCPs are getting patients they would not have gotten. Now that is a step in the right direction for population health improvement. MinuteClinics are opening up their 1000th clinic this summer, and certainly more will follow. Technology is playing an important role here, as well, with minimally invasive and inexpensive devices that can check status, say of a child’s ear infection, and transmit that to the clinic so a prescription can be written and delivered without the child having to leave the home.

The bottom line is that the healthcare delivery system is changing. Jim Pyles said that in his 43 years in health care law he has never seen such change. How providers are being paid is changing. How care is measured is changing. Incentives to share risk and find a way to reduce costs are working. Strange bedfellows are now collaborating and looking for ways to achieve that triple aim: lower costs, better care and better population health.

The opportunities that abound for home care are amazing. Because home care is the least expensive alternative (in most cases), and because better care can be offered at home in the least restrictive setting, and most comfortable for the patient, there are almost unlimited opportunities for those who are not afraid to change, to take some risk and to think in a futuristic manner.

Thanks to my friends at Axxess for sponsoring my continued foray into the future. Come see Sam Smith, VP of Business Development and me present on the future of home health at the Pennsylvania Homecare Association on May 13th and the Home Care Association of Florida July 30th.