The Future of Home Health Care Workshop Summary (2015) / Chapter Skim
Currently Skimming:
9 Reflections and Reactions
9 Reflections and Reactions
Pages 117-128
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From page 117... ...
Some of the recurrent topics identified by these individuals are highlighted in Box 9-1. The following sections are the reflections and reactions of the members of these two panels.
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From page 118... ...
Edes, in particular, she said, demonstrated how helpful information can be in program development. Targeting of high-risk, high-cost, and vulnerable populations for home-based primary care unquestionably requires a more diverse and skilled workforce, and his data showed "how much better it is to approach these clients at the primary care phase rather than waiting until they need restorative care," Labson said.
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From page 119... ...
Stone described some of the different types of health workers in the direct care workforce, with each one having somewhat different, but sometimes overlapping, responsibilities and capacities. According to Labson, Stone provided a realistic appraisal of the future of the direct care worker, which will be affected by the • shrinking availability of family caregivers, • changing demographics of direct care workers and their patients, • availability of career lattices that allow ongoing career development, • low wages and scant benefits, and • overall health of the U.S.
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From page 120... ...
To identify these patients, Lee noted, most of the models use various types of risk stratification, which requires health information systems sufficient to perform such stratifications, adequate patient assessment protocols, and data analytics. Lee said the diverse care delivery and payment models described encompassed everything from advanced illness management to bundled payment arrangements, accountable care organizations, home-based primary care, and hospital at home, all with home health or home-based care components.
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From page 121... ...
; and total costs per enrollee. According to Lee, the policy and payment reforms that would strengthen these models and allow their expansion included the following: appropriate reimbursement for services geared to the stabilization or improvement of patients' functional status; approaches to the use of bundled payments for post-acute care that allow more flexibility in the delivery of care through the use of a waiver of the Medicare requirement that patients be homebound and improved coordination with primary care; encouragement of the use of capitation, which also facilitates flexible payment approaches; and the use of value-based purchasing.
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From page 122... ...
-led holistic care plans, an enhanced capacity for an acute care response, thoughtful use of information technology to fill gaps and to communicate, and enhanced support during transitions. She also reiterated his message that home health "must rise to the occasion and embrace value creation." Bowles indicated that speakers also emphasized the importance of the provision of care by interdisciplinary teams and occasionally mentioned the importance of including the patient and family caregiver as part of the team.
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From page 123... ...
Technologies are needed that support medication administration, reconciliation, and reminders; that send information to clinicians, including decision support, at the point of care; that can take on some of the inefficient, repetitive teaching in home health care; and that can provide support through the use of social networks. Although telehealth may be a useful tool for the field, she said, much more needs to be learned about it so that it may be used effectively and efficiently.
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From page 124... ...
This is short-sighted and counterproductive for beneficiaries, providers, and the Medicare program, Stein said. The interpretation of Medicare rules that limits home health care to post-acute care situations remains a serious problem, despite the Jimmo v.
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From page 125... ...
He sees care in the home to be a proverbial three-legged stool, supported by health care, social services, and function. In his model, health care is not about a set of consultative clinicians and supporting professionals; it is about an interdisciplinary team working for a population "to whom they are responsible personally and accountable to society." The social work leg of the stool should involve not just the brokering and pulling together of services, as they are now mostly used, but also counseling of patients and family caregivers and provision of a community organization function, he said, enjoining family, friends, and local agencies, such as the neighborhood village movement.
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From page 126... ...
Going further, he said that with the right financial incentives, within 4 hours it is possible to create a nursing home, hospital, or intensive care unit in a patient's bedroom. "There's no need to go to a hospital for the vast majority of problems, except major surgery, invasive procedures, and complex imaging." Preoperative and postoperative care can be done at home with ICU-level monitoring devices wirelessly connecting to a central telemetry unit.
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From page 127... ...
When the future is considered, the health care system has a tremendous regulatory burden with respect to what is accomplished in that first home health visit. As a result, she said, home health providers are not necessarily focused on accomplishing what is of the greatest importance to patients until the second, third, or fourth visit.
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