Value-based care is driving major change in the healthcare industry. As payers redirect their focus from service delivery to patient outcomes, new reimbursement models have emerged to reward providers who can demonstrate an efficient, patient-centered care experience.

The homecare industry is poised to accelerate this transformation. With direct insight into the health and environments of the people they serve, homecare aides can address the many factors that influence patient outcomes. As a result, homecare providers offer an incredible opportunity for managed care organizations (MCOs) to gather the data they need to successfully implement value-based care.

To better understand the potential of homecare in the shift to value-based care, we spoke with two HHAeXchange executives, Kimberly Glenn, Senior Vice President of Government Health Plans, and Stephen Vaccaro, President of Provider Solutions. Glenn’s role as payer lead and her years of experience working in the government sector make her an ideal source for understanding the payer’s point of view. Vaccaro, as provider lead for HHAeXchange, is attuned to what this means day-to-day for homecare agencies. He offers practical advice on how homecare organizations can adapt and succeed within this new model. Together, they provide a well-balanced perspective on the issue.

In the Q&A that follows, we’ll discuss the impetus for value-based care, its implications for MCOs, and how the homecare industry can leverage its unique position in the healthcare ecosystem to deliver on the promise of value-based care.

What were the primary drivers of this shift to value-based care?

“The movement toward value-based care was driven by a combination of unsustainable healthcare spending and an aging demographic, many with significant health issues,” says Stephen Vaccaro. “These twin challenges prompted both payers and providers in the healthcare industry to take a hard look at what fee-for-service payment models were incentivizing.”

Kimberly Glenn adds that the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) “really shifted the fee-for-service paradigm and changed the way Medicare rewards clinicians. The involvement from some of the largest healthcare purchasers, like Medicare, Medicaid, and employers, moved value-based care from concept to practice.”

How are MCOs adapting to value-based care?

“In my work with MCOs, I’ve seen a variety of strategies emerge,” Glenn says. “Many are implementing care coordination models – conducting an initial care assessment, developing a plan of care with an interdisciplinary team, and monitoring and reporting on outcomes. In other words, they’re building evidence-based, integrated clinical care models to effectively manage members’ total healthcare needs.”

What do alternative reimbursement models look like?

“At the federal level, we’re seeing bundled payments, shared savings, capitation, and other new payment models,” Glenn says. “There are also a growing number of accountable care organizations (ACOs), which hold providers jointly accountable for their patients’ health. Often there are financial incentives to cooperate and financial savings from the avoidance of unnecessary tests and procedures.”

She added, “State Medicaid programs are taking similar approaches. For example, New York state implemented the Delivery System Reform Incentive Payment program (DSRIP), which aligns payer and provider incentives, focusing on holistic care that addresses prevention, primary care, and overall health and wellness.”

Why are homecare providers uniquely positioned to advance value-based care?

“Value-based care places a greater emphasis on prevention and social determinants of health,” says Vaccaro. “Both are critical factors in reducing the cost of care and improving patient outcomes.”

He noted that unlike other healthcare environments, homecare providers and their caregivers are a consistent presence in a patient’s life. They can:

  • Ensure adherence to customized care coordination plans, such as monitoring blood pressure and taking prescriptions
  • Report on non-medical issues like food insecurity, social isolation, and housing instability, offering both observations and recommendations
  • Encourage the individual to take preventive steps to maintain health and wellness

With the right approach, homecare services can have a measurable impact on patient satisfaction and health outcomes.

How can homecare organizations demonstrate their impact to MCOs?

“First and foremost, homecare providers must establish a disciplined, structured approach to homecare data gathering,” says Vaccaro. “Homecare aides need a simple, straightforward method for reporting and evaluating data, which can often be accomplished with a technology solution that supports both telephony and mobile app.”

He recommends investing in a homecare technology platform that will notify the caregiver to document specific aspects of a member’s condition and other important factors, creating a consistent process for capturing information.

“Second, homecare providers need to identify and track the quality metrics that correlate with improved patient outcomes,” Vaccaro says. “Ultimately, the better your handle on patient outcome data, the more opportunities you have to show your value to payers.”

HHAeXchange’s homecare management solution offers built-in business intelligence tools that help homecare providers manage this data. The web-based platform is designed to empower agencies with a new value-based care tool that prompts caregivers with patient-specific questions upon clocking out through the HHAeXchange mobile app. Using this data, agencies can stay up-to-date on patient status and track trends to reduce readmissions and unnecessary hospitalizations.

Glenn adds, “The bottom line is – Homecare agencies that make it easier for MCOs to see the real impact they’re having on their patients will have a major advantage in the years to come. Value-based care isn’t a trend; it’s here to stay.”

To learn more about how HHAeXchange can help your agency deliver and demonstrate value-based care, schedule a demo.