COVID-19 shined a spotlight on the value of homecare and its ability to help individuals age safely in the comfort of their homes. But while policymakers, providers, and payers may have acknowledged homecare as a strong alternative to facility-based care during the pandemic, some may not be realizing its full potential – for now and the years to come.
Homecare is valuable not only as a form of care delivery, but also as a means to collect the data needed to reduce adverse and costly events for members. As the industry shifts to a value-based care model, access to this data is more critical than ever. Here, we’ll explain why homecare providers and caregivers are in the prime position to gather such insights, and how MCOs can leverage that data to drive better outcomes for all.
The Centers for Medicare and Medicaid Services (CMS) defines value-based care as: “paying providers based on the quality, rather than the quantity of care they give patients.”
There are multiple factors that influence the overall quality of care a member receives. There are clinical factors – medical care and the nature and consistency of that care – which are estimated to account for only 10 to 20 percent of the modifiable contributors to health outcomes in a population. The remaining 80 to 90 percent are social determinants of health (SDOH), which include health-related behaviors, socioeconomic factors, and physical environment factors.
The U.S. Department of Health breaks social determinants into five categories:
To develop an effective population strategy, both clinical factors and social determinants of health, in addition to member surveys and census data, should be addressed by stakeholders.
Historically, care and disease management programs relied on standardized diagnosis and treatment options for particular conditions, with the primary goal of controlling costs. But these may not have been as impactful as expected because they did not account for the various SDOH factors that have been proven to directly impact a plan of care.
Due to the frequency of their visits and the personal, hands-on nature of their work, caregivers in a member’s home have key insights into their clients’ health and well-being that others within the healthcare continuum might not. For example, they’ll tend to notice if the member is eating or drinking less, or if they seem more agitated, weak, or nervous than usual. They also may be able to identify social and environmental issues, such as mold in the home, an empty refrigerator or kitchen cupboard, trip and fall hazards, or a lack of family, friends, or neighbors with whom the member can connect.
With simple training on signs to look out for and the right questions to ask, caregivers can observe, note, and report changes in condition and other potential health risks back to the health plan’s care management team. Data can be made actionable before a condition worsens or a social determinant, or other risk factors, start to have a negative impact on overall health, resulting in the avoidance of a costly hospital visit or other adverse event.
Technology can aid not only in streamlining member observations, reporting procedures, and prompting action, but also in collecting data that can be utilized to develop effective population strategies for the future. For example, HHAeXchange offers a caregiver mobile app that automatically prompts caregivers with relevant, pre-defined questions regarding their clients. This information is documented and reported back to their care management or care coordination team, helping them to monitor potential or recurring issues and avoid possible risk escalations. This observation and reporting data is visible in real-time, and over time, for use by both providers and MCOs.
In order to ensure value-based care, home and community-based quality measures and clinical care gaps for individual members must also be addressed. Fortunately, with transparent communication and the right technology, homecare payers and providers can work together to achieve better outcomes.
Ideally, the first step is for payers to identify the needs of individual members which may span traditional quality measures as well as person-centered goals. Then, providers should be notified of the relevant care measures for each member so they can aid in getting members the services and supports they need. Technology like HHAeXchange’s Quality Insights allows for direct communication between the payer and HCBS provider, so timely updates can be provided on the status of the care needed. It also supports incentives to providers for promoting adherence to specified standards of care.
HHAeXchange’s Quality Insights solution can be leveraged to help support MCOs in meeting CMS’s newly emerging HCBS Quality Measures, currently voluntary, and expected to be finalized in 2023.
An effective population health strategy takes into account all forms of information for essential risk stratification – home health visits, social determinants of health, clinical factors, and census data. With the right tools, caregivers, providers, and payers can work together to collect this information in the home, initiate the proper care services, and drive better outcomes for all members.
To learn more about how HHAeXchange’s Value-Based Care Solutions can support your population strategies, contact us.
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