Top Trends in Technology-Enabled Home Care | Blogs | Health law today

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The traditional world of Medicare-certified home care and hospice care is changing rapidly. To the surprise of many, although the pandemic has been an accelerator, the reasons are more fundamental and lie at the heart of the forces affecting the healthcare industry as a whole. These forces were on full display at the sold-out 20and HC100 Annual Conference in Phoenix this week. I had the privilege of listening to former CMS Administrator Seema Verma, former Vice President Al Gore, the CEOs of all the major home health companies and their investors at a three-day conference on the state of the industry. I also moderated a panel led by Seth Sternberg and Jessie Brumbach, CEO and Chief Brand Officer for Honor Home Health, respectively.

Main takeaways:

1. Labor – No one is surprised by the labor shortages in this sector given the relative levels of wages and benefits and the competition for workers. What was essential was that the shortage of health care workers is, for the foreseeable future, permanent given the health care needs of baby boomers, shortages of nurses and competitive career paths for young people. Companies such as Honor Home Health have focused on using technology in the workforce to professionalize caregivers in the unskilled field to reduce churn and increase enumeration.

2. New Delivery Models – All avenues lead to better non-hospital options for consumers, plans and health systems. Nearly 200 hospitals now participate in CMS’s Home Hospital Waiver Program allowing for full diagnostic related group (DRG) payment. Extensions of these derogations with CMS are now essential. Many companies have developed models of care that combine clinical, technology and logistics, including Medically Home. The pending Home Care Act that would allow Skilled Nursing (SNF) facilities to move out of acute home care facilities would be a major boost for the home-based SNF model (which until now , was largely a function of bundled payment episodes and Accountable Care Organization (ACO) agreements for home care as a downstream provider to hospitals and physician groups). Many of these programs show promise, but the focus on the patient is narrow and will not replace broader technology-enabled unskilled home care models.

3. Technology and data – Proving savings and better results with data is easier said than done in some cases; however, technology can provide the means to achieve this when combined with collection and caregiver education. Many substance use disorder (SUD) providers have done a good job in this area and have compiled excellent multi-year outcome data to initiate plans. Nevertheless, aside from the waivers for telemedicine associated with the pandemic, it is more difficult to adopt the technology at the caregiver level in the field of home health, where a more experienced workforce can resist the technology instead of in-person visits or delegating virtual care to others. Fee-for-service (FFS) reimbursement is still an issue for telemedicine and remote patient monitoring (RPM).

4. Medicare Advantage and Value-Based Care – Value-Based Care (VBC), primarily through the advancement of Medicare Advantage (MA) and not through the Centers for Medicare & Medicaid Services Innovation Center (CMMI) programs, will continue to ramp up. Without technology to alleviate a labor shortage and collect good data, vendors will struggle when negotiating with these plans. VBC is not an option now; it is a basic deliverable. Pricing and planning are difficult, but necessary.

5. Personal care – Traditional FFS home care and palliative care services have often viewed unskilled home care as an adjacent non-essential service offering. This situation is changing rapidly as evidence mounts that non-clinical care addressing the social determinants of health can provide better and less costly outcomes. Large platforms are moving to provide technology-enabled home care that partners with MA plans, self-insured plans, and FFS providers under risk agreements. Streamlining the labor supply in this space will be the main hurdle. Technology will be a huge factor.

6. Primary care and home care-longitudinal care – The integration of primary home care with home health, palliative care and palliative care, especially for complex patients, has been successful to date (see Landmark, Dispatch, Heal). MA has fully embraced this model for complex patients and the admission, readmission, length of stay (LOS) and discharge data confirm this. Retaining primary care physicians interested in this space is a key goal for these companies, as is deploying technology and logistics for durable medical equipment (DME), transportation, and personal care support. These companies directly feed into the themes of the new delivery model mentioned above.

2022 will be an exciting and changing year for home healthcare – the shift to technology-enabled home care in a much more extensive way than in the past will go forward, fueled by technology and substantial investment from private capital and strategies supporting new delivery models.

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