Home Care Association of America 9 2016 value based care 9-20

Value Based Care Initiatives

New Revenue Opportunities for Private Duty Home CareSTEVEN C. FOX D.O.

PRESENTERHome Care Association of America Leadership ConferenceSeptember 26, 2016

Mergers, Acquisitions, and Money

Home Care Association of America Leadership Conference September 26, 2016


1,968 New and Expanded Secretarial Powers Under the Health Reform Law


U.S. Health Spending and Gross Domestic Product


U.S. Health Spending Trends 2015-2024


30 million adults in the U.S. have two or more

chronic Illnesses.

THE PROBLEM

Home caregivers are managing six or more medications, wound care, special diets, monitors, and specialized medical equipment.


THE COST

71¢ of every dollar of US healthcare spending goes to treating people with

Multiple Chronic Illness

93¢ of every dollar of Medicare expenditure

goes to treating people with Multiple Chronic Illness

Avoiding a single hospitalization can save over

$15,000 per patientSeptember 26, 2016Home Care Association of America

Leadership Conference

Home Care Association of America Leadership Conference

Description of Home Health Care User

September 26, 2016

A. The user has no illness (acute or chronic) and uses self-help sources

B. The user is ambulatory, independent, and not “sick”; some chronic health conditions exist

C. The user is younger, and functions (ADLs) are limited by one condition; the user is not “sick” often but needs continuous ADL support


Description of Home Health Care User (Cont.)

D. The user is older with chronic cognitive or functional impairment; the user is infrequently acutely ill (low cost) and needs ADL support

E. The user requires post-acute care at the end of a discrete illness episode but has a rapid return to stable condition and home health care ends

F. The user has a high comorbidity and illness burden and is sick, and the cost of care is high

Centers for Medicare & Medicaid Services (CMS)

Triple Aim Improving the patient experience of care

(including quality and satisfaction)

Improving the health of populations

Reducing the per capita cost of healthcare



(CMS) Models of Home-Based Care Community-based care transitions program

Geriatric resources for assessment and care of elders (GRACE)

Program of all-inclusive care for the elderly (PACE)

Home-centered primary care

Independence at home (IAH)

September 26, 2016Home Care Association of America Leadership Conference

Value =

Health Outcomes AchievedCost of Achieving Outcomes

The fundamental goals of Value Based Care are to:

• Improve outcomes, primarily through reduced practice variability and adoption of “best practices” but also by engaging patients in their care

• Lower the cost of achieving those outcomes, by lowering the underlying cost of delivering services and reducing unnecessary utilization

• Coordinate care to reduce fragmentation of services

Healthcare Value Defined

Payer source move toward value based bundled payments.

By 2018, 80% of all healthcare payments will be tied to value and outcome.

This shift will dramatically increase patients being remotely monitored in the community.


The Future of Value Based Payment


Hospital Condition

PAC Averag

e

OP Rehab

Home Health

SNF IRF LTCH

Stroke $10,680

$569 $2,478 $8,527 $18,923

$22,070

Hip & Femur Procedures for Trauma

$10,392

$1,217 $2,595 $8,761 $16,018

$22,738

Cardiac Bypass with Catheterization

$5,230 $837 $1,778 $5,737 $14,631

$24,526

Heart Failure $4,144 $612 $1,611 $6,462 $14,698

$20,236

Cost of Post-Acute Care in Comparison for Various

Procedures




V(VALUE)

Q(QUALITY)

S(SERVICE)

$(COST)

September 26, 2016

Proving Your Worth


• Technology

• Teams• Outcomes

What You Will Need

September 26, 2016


• Identify and become knowledgeable about your partner

• Have a specific patient population

• Find administrative and clinical champions

How to Partner


HOME CARE METRICS℠ is a technology driven responsive

integrated care system.


Hospitalization Risk 12 point scale

FunctionalAssessment240 point scale

HOME CARE METRICS℠

PATIENT ASSESSMENT

Personalized MetricsChange in Condition

Alerts


September 26, 2016

Hospital

Hospital-Based Diagnostics

Specialist Physicians

Primary Care Physicians

Home-Based Primary

Care PhysiciansHome-Based

Nursing, Therapy, and Caregivers

Mobile DiagnosticsSpecialist

Physicians Hospital Home-Based

Palliative/ Hospice Option


The Future

Value Based Care Initiatives

New Revenue Opportunities for Private Duty Home CareSTEVEN C. FOX D.O.

[email protected]

Home Care Association of America Leadership ConferenceSeptember 26, 2016

Thank you for attending this session.

Please go the Annual Leadership Conference App and complete the survey for this session now!