cost effective home care in massachusetts

7/30/2019 Cost Effective Home Care in Massachusetts

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CONSIDER HOME CARE

Health Cares Cost Effective

Solution


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Section 1

An Overview

Why Home Care?And Why Now?


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Why Home Care? Why Now?

Fact:

Innovative, low cost, evidenced-

based practices are being used in

home health care today to achieve

the goals for safe, effective,

patient-centered care that are at

the heart of new global payment,

medical home or accountable care

contracts.

As part of a plan of skilled and supportive

care, home health agencies have in place an

infrastructure to:

Reconcile and assure adherence to

medications;

Initiate personalized teaching and health

coaching for chronic illness, self-

management support strategies;

Conduct in-home safety evaluations,

depression screening, and falls risk

assessment; and

Coordinate other non medical community

resources;


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Why Home Care?

High quality home health agencies have capacity to:

Provide intense clinical interventions at home (e.g., providing a

patient after only two hospital days with a course of 14 days home IV

antibiotic) ;

To assist in managing risk (e.g., this same patient has much lower risk

of nosocomial IV line infection); and

Because of their intense focus on patient and family goals, to improvepatient satisfaction scores.


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Together We Have a Lot of Work To Do

Source: Medicare Hospital Quality Chart Book, 2012


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No... but, of 2,836 hospitals included in the measure, 2.7% performed better

than the national rate of 5.7%, and 1.8% performed worse than the national

rate. Four divisions (New England, Middle Atlantic, East North Central, and

East South Central) had more hospitals that performed worse than the

national rate than hospitals that performed better.

And We Can Do Better..


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Hospital Discharge Disposition - MA

Data: January 2011- December, 2011, Source: Masspro


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Clinically and Cost Effective Placement

Innovative approaches to the use of

post-acute care could be key to

improving patient care at a lower

cost

A recent study showed that

patients with similar clinical and

demographic characteristics are

receiving post-acute care in various

settings

Example:

Comparing average payments across

first post acute settings, it is clear

that home health is the most cost-

effective. For example, the averagefirst setting Medicare payments for

MS-DRG 470 (major joint

replacement) are:

http://www.ahhqi.org/research/efficient-care

Home Health $3,267

Skilled Nursing Facilities $8,981

IRF $13,073

LTCH $27,399
http://www.ahhqi.org/research/efficient-carehttp://www.ahhqi.org/research/efficient-carehttp://www.ahhqi.org/research/efficient-carehttp://www.ahhqi.org/research/efficient-care


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Section 2Improving Care Transitions/Reducing

Readmissions


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Seamless Transitions

At the time of the first home visit (usuallywithin 24 hours), your patients:

Home environment is assessed forhazards that might increase risk of a fallor other injury;

Medications are reconciled andteaching is initiated to supportcompliance; and

Need for referrals for therapy, homehealth aides, &/or social work areevaluated.

Example:

Complications of a late Friday

discharge can be avoided with ahomecare nurse or therapist visit the

next day to ensure ordered

medications are in the home,

discharge instructions are in place

and being followed, appointments

are set as needed, direct care

provided as ordered.

A referral to home care following a hospital discharge or an emergency room visit gives patients

the support and services they need to stay safe at home.


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Preventing Re-hospitalization

Massachusetts Medicare patients who

are referred for post acute home health

services will receive an average of 20

visits within 60 days of leaving the

hospital;

Patients leaving the hospital can also be

referred for care transition support,

outside of the Medicare benefit, on a

fee for service basis for a one time

home or medication evaluation, short

term coaching or telephonic support,

to support compliance with discharge

orders, or setting up a private pay care

plan.

Example:

A patient who has fallen at home once is

more likely to do so again. Yet patients

suffering from balance dysfunction can find

it difficult to travel to outpatient

rehabilitation programs because they arenot mobile enough or cannot find a

caregiver to transport them.

A home-based falls risk assessment can

evaluate and address changes to a

cluttered living area, risks from medication

side effects, or elevated blood pressure, as

well as issues with strength or flexibility.

The plan may involve home modification

advice and balance therapy.


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The Home Care Teamwork Approach

In a post acute episode of care, home health is required to coordinate

with the patients Primary Care Physician.

The home care nurse or therapy team will:

Contact the physician to establish patient-specific clinical parameters for notifying

him/her of changes in vital signs or other clinical findings;

Work with the patient and family on the importance of patient follow-up with the

physician within 5 days of discharge and assure that appointments are set up;

Provide patient/family instruction on early indicators of symptom exacerbation and

whom to contact, what to do, and under what circumstances; and

Collaborate on highest risk patients, including those who may not be able to access an

MD office either permanently or temporarily.


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Focus on Patient Education

Example:

Patients go to the ED when they

cant reach a professional caregiver.

Home care teaches the

patient/family to contact a member

of the home care team first, for

concerns about increasingsymptoms or changes in their health

status.


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Section 3Managing Chronic Illness


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Managing Chronic Illness

Studies show that as the number of chronic conditions increases so do

hospitalizations. Beneficiaries with multiple chronic Illnesses account

for the MAJORITY of all hospital readmissions.

Only 4% of beneficiaries with 0 or 1 chronic condition were hospitalized and less

than 1% were hospitalized 3 or more times during the year;

Almost two-thirds of beneficiaries with 6 or more chronic conditions were

hospitalized and 16% had 3 or more hospitalizations during the year.


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A Picture Tells the Story


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Home Care Knows Chronic Illness Management

Home health care clinical teams, under directives from physicians, are able tohelp patients manage chronic disease effectively at home, resulting in significant

reductions in unnecessary hospitalizations.

The home care based chronic care model includes:

High touch hands on care and teaching often from teams with specialty

training and managing and teaching clients with diabetes, congestive heart

failure and chronic obstructive pulmonary disorder;

Technology, in the form of remote monitoring or Telehealth that transmit

vital signs daily providing for early identification of changes in condition andmore timely interventions leading to reduced hospitalizations; and

Self management support around management of a chronic illness.


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Example

For CHF patients, an HHA can provide

critical services to prevent hospitalizations or

ER visits, including:

Conducting one on one education about

the CHF Zones of Management and

when and whom to call for help;

Teaching how to take and manage

medications and diet, especially sodium

intake;

Teaching use of oxygen in the home;

Conducting in home or remote observation

of weight, breathing, presence of edema

or pulmonary crackles.

Fact:

Most physician groups are

not equipped to

effectively managechronically ill patients.

Home care can be the

extension of the physician

practice, providing the

varied disciplines, patient

education and in-homevisits.

Home Care Knows Chronic Illness Management


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Section 4

Managing AdvancedIllness


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What is Palliative Care?

Specialized or generalist medical care for people with serious illness and their

families;

Focused on improving quality of life as defined by patients and families;

Provided by an interdisciplinary team that works with patients, families, andother healthcare professionals to provide an added layer of support; and

Appropriate at any age, for any diagnosis, at any stage in a serious illness, and

provided together with curative and life-prolonging treatments.

Definition from public opinion survey conducted by ACS CAN and CAPC http://www.capc.org/tools-for-palliative-care-

programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdf

Diane Meier, Center to Advance Palliative Care
http://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdfhttp://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdf


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Palliative Care Teams Address Three Domains

1. Physical, emotional, andspiritual distress;

2. Patient-family-professionalcommunication about

achievable goals for care andthe decision-making thatfollows; and

3. Coordinated, communicated,continuity of care and supportfor social and practical needs ofboth patients and familiesacross settings.

Dont ask whats

the matter with me.Ask what matters

to me.


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13.211.1

2.3

9.4

4.6

35.0

5.3

0.92.4

0.9

0

10

20

30

40

Home health

visits

Physician

office visits

ER visits Hospital days SNF days

Usual Medicare Palliative care intervention

Palliative Care at Home for the Chronically IllImproves Quality, Markedly Reduces Cost

Service Use Among Heart Failure, Chronic Obstructive Pulmonary Disease, or Cancer Patients

While Enrolled in a Home Palliative Care Intervention or Receiving Usual Home Care, 19992000

Source: KP Study Brumley, R.D. et al. JAGS 2007; Diane Meir, Center to Advance Palliative Care


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1) Advanced life-limiting illnesses? Severe dementia (unable to bathe, urinary incontinence, etc.)

Severe CNS disease (e.g., recent acute stroke, progressive neurological decline)

Cancer (with or without metastasis)

Congestive heart failure (with marked activity limitation)

Chronic obstructive pulmonary disease (requiring home O2)

AIDS (CD4


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78%

78%

79%

79%

80%

80%

81%

81%

82%

82%

State National

82%

79%

Would patients recommend the home health agency to friends &

family?

Home Care Delivers Satisfied Patients


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Patient Satisfaction Survey

83%

84%

84%

84%

84%

84%

85%

85%

85%

85%

State National

85%

84%

How do patients rate the overall care from the home health agency?

cost effective home care in massachusetts

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