What Every Homecare Provider Needs to Know About Value-Based Care

Value-based care. It seems to be the trending topic these days.

Still, many homecare providers aren’t exactly sure what value-based care means, or why it’s important.

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.” The objective is to create reimbursement systems that drive clinical practice improvement and patient outcomes while controlling cost.

Value-based care is a payment model that rewards providers when they help patients improve their health, reduce the impact of chronic disease, and live healthier lives. This approach encourages innovation and efficiency. On the other hand, fee-based models simply create an incentive for a higher volume of services. This may or may not lead to the best outcome – for patients, providers, or payers.

But why the shift?

A Different Mentality

In response to unsustainable healthcare spending and an aging demographic, the healthcare industry is moving from a fee-for-service model to a value-based care model. You may have noticed that payers like states and managed care organizations (MCOs) have begun to redirect their focus from the quantity of services delivered to the quality of care provided.

Homecare providers must prepare for this change. Over time, compensation for in-home patient care will increasingly be based on keeping patient populations healthy, rather than on the number of services performed.

First and foremost, states and MCOs want to ensure that their managed populations are healthy enough to stay in their homes (and out of the hospital). Therefore, they prefer homecare agencies that reduce hospital readmissions and prevent unnecessary hospitalizations.

As an agency owner, you might now be wondering:

1. How can I improve patient outcomes?
2. How do I prove my agency’s value to payers?

Depending on your approach, the answers might not be as complex as you think.

Equip Your Homecare Aides with the Right Tools

Agencies must embrace and support the role their homecare aides can play in driving value. Remember — your caregivers are the windows into your patients’ health and the state of their homes. Empower your aides by teaching them what to look for and the right questions to ask.

Incorporate Early Warning Methods

An ideal place to start is the early warning documentation tool known as STOP and WATCH. Developed by INTERACT® (Interventions to Reduce Acute Care Transfers), STOP and WATCH is a vertical acronym of conditions that assist in early identification of patient changes, reducing the risk of potentially avoidable hospitalizations.

Once a caregiver observes a change in patient condition, they simply fill out the STOP and WATCH form and promptly submit it to a licensed nurse or supervisor, who then evaluates the patient and determines the necessary course of action.

Use Technology to Improve Reporting

Keep in mind that without the right tools, the data collection process is often haphazard, lacks accuracy or reliability, creates false alarms, and relies on the gut instinct of the caregiver to determine whether the member needs elevated care. When caregivers lack clinical skills, it can be risky or costly to rely on them to interpret what they’re seeing in the member’s home.

Technology can aid in streamlining patient observations and reporting procedures. For example, HHAeXchange offers a caregiver mobile app that automatically prompts aides at the time of clock-out with pre-defined questions regarding the patient’s condition. Caregivers can also add non-diagnosis-related observations to track changes such as a patient running low on medication or a malfunctioning medical device. If there are any negative changes in a patient’s health based on an aide’s response or observation, the app will notify your agency immediately.

Source: pathway-interact.com

Know your Quality Metrics

Delivering optimal care and improving patient outcomes are your top goals as a homecare provider. However, if MCOs are not aware of your agency’s strengths, you won’t be recognized for the value you bring.

Identify the Metrics that Show Value

If you’re not sure what metrics you should provide, put yourself in the payer’s shoes: If you’re looking for homecare agencies you can trust, what would you want to see?

To stand out to payers, homecare providers should measure the following criteria:

• Hospital readmission rates
• Completion of scheduled visits
• Adherence to plans of care
• Hours delivered
• Billing accuracy

Develop a System for Data Collection

For agencies that rely on manual processes to run their business, measuring this data could be a challenge. After all, managing an agency is hard enough, and the hours it would take to compile these metrics would be prohibitive.

Fortunately, technology can help agencies automatically track their quality metrics, improve patient outcomes, and optimize their overall business functions. For example, HHAeXchange’s value-based care tool prompts caregivers with patient-specific questions at the time of clock-out, creating a seamless way for agencies to collect value-based data as part of the EVV process. Using this data, agencies can stay up-to-date on patient status and track trends to reduce readmissions and unnecessary hospitalizations.

The Big Picture

Value-based care models make patient outcomes a priority, increasing accountability on the part of homecare providers, doctors, hospitals, and health systems. When applied effectively, this approach benefits the entire homecare ecosystem.

After all, when providers get paid for helping patients stay healthy and out of the hospital, everyone wins.

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