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

Value Based Care Initiatives
New Revenue Opportunities for
Private Duty Home Care
STEVEN C. FOX D.O.
PRESENTER
Home 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 patient
September 26, 2016
Conference

Description of Home Health Care User
September 26, 2016
Conference
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

September 26, 2016
Conference
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

September 26, 2016
Conference
(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, 2016
Conference
Value =
Health Outcomes Achieved
Cost 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.
September 26, 2016
Conference
The Future of Value Based
Payment

September 26, 2016
Conference

Hospital
Condition
PAC
Averag
e
OP
Rehab
Home
Health
SNF IRF LTCH
Stroke $10,68
0
$569 $2,478 $8,527 $18,92
3
$22,07
0
Hip & Femur
Procedures for
Trauma
$10,39
2
$1,217 $2,595 $8,761 $16,01
8
$22,73
8
Cardiac
Bypass with
Catheterization
$5,230 $837 $1,778 $5,737 $14,63
1
$24,52
6
Heart Failure $4,144 $612 $1,611 $6,462 $14,69
8
$20,23
6
Cost of Post-Acute Care in
Comparison for Various Procedures

Proving Your Worth

Conference
• Technology
• Teams
• Outcomes
What You Will Need
September 26, 2016

September 26, 2016
Conference
• 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.
September 26, 2016
Conference

Hospitalization Risk
12 point scale
Functional
Assessment
240 point scale
HOME CARE
METRICS℠
PATIENT
ASSESSMENT
Personalized Metrics
Change in Condition Alerts
September 26, 2016
Conference

September 26, 2016
Hospita
l
Hospital-Based
Diagnostics
Specialist Physicians
Primary Care Physicians
Home-
Based
Primary
Care
PhysiciansHome-Based
Nursing, Therapy,
and Caregivers
Mobile Diagnostics
Specialist
Physicians
Hospital
Home-Based
Palliative/ Hospice
Option
Conference
The Future

Value Based Care Initiatives
New Revenue Opportunities for
Private Duty Home Care
STEVEN C. FOX D.O.
PRESENTER
FOX@GERI-DOCTOR.COM
Home Care Association of America
Leadership Conference
September 26, 2016

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

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