Transcript Health Care`s Cost Effective Future

Health Care’s Cost Effective
Solution
CONSIDER HOME CARE
Section 1
An Overview
Why Home Care?
And Why Now?
Why Home Care? Why Now?
As part of a plan of skilled and supportive
care, home health agencies have in place an
infrastructure to:
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Reconcile and assure adherence to
medications;
Initiate personalized teaching and health
coaching for chronic illness, selfmanagement support strategies;
Conduct in-home safety evaluations,
depression screening, and falls risk
assessment; and
Coordinate other non medical community
resources;
Fact:
Innovative, low cost, evidencedbased 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.
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 improve
patient satisfaction scores.
Together We Have a Lot of Work To Do
Source: Medicare Hospital Quality Chart Book, 2012
And We Can Do Better…..
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.
Hospital Discharge Disposition - MA
Data: January 2011- December, 2011, Source: Masspro
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
http://www.ahhqi.org/research/efficient-care
Example:
Comparing average payments across
first post acute settings, it is clear
that home health is the most costeffective. For example, the average
first setting Medicare payments for
MS-DRG 470 (major joint
replacement) are:
Home Health
$3,267
Skilled Nursing Facilities
$8,981
IRF
$13,073
LTCH
$27,399
Section 2
Improving Care Transitions/Reducing
Readmissions
Seamless Transitions
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.
At the time of the first home visit (usually
within 24 hours), your patient’s:
 Home environment is assessed for
hazards that might increase risk of a fall
or other injury;
 Medications are reconciled and
teaching is initiated to support
compliance; and
 Need for referrals for therapy, home
health aides, &/or social work are
evaluated.
Example:
Complications of a late Friday
discharge can be avoided with a
homecare 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.
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 are
not 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.
The Home Care Teamwork Approach
In a post acute episode of care, home health is required to coordinate
with the patient’s 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.
Focus on Patient Education
Example:
Patients go to the ED when they
can’t reach a professional caregiver.
Home care teaches the
patient/family to contact a member
of “the home care team” first, for
concerns about increasing
symptoms or changes in their health
status.
Section 3
Managing Chronic Illness
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.
A Picture Tells the Story
Home Care Knows Chronic Illness Management
Home health care clinical teams, under directives from physicians, are able to
help 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 and
more timely interventions leading to reduced hospitalizations; and
 Self management support around management of a chronic illness.
Home Care Knows Chronic Illness Management
Fact:
Most physician groups are
not equipped to
effectively manage
chronically ill patients.
Home care can be the
extension of the physician
practice, providing the
varied disciplines, patient
education and in-home
visits.
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.
Section 4
Managing Advanced
Illness
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, and
other 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-careprograms/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdf
Diane Meier, Center to Advance Palliative Care
Palliative Care Teams Address Three Domains
“Don’t ask what’s
the matter with me.
Ask what matters
to me.”
1.
Physical, emotional, and
spiritual distress;
2.
Patient-family-professional
communication about
achievable goals for care and
the decision-making that
follows; and
3.
Coordinated, communicated,
continuity of care and support
for social and practical needs of
both patients and families
across settings.
Palliative Care at Home for the Chronically Ill
Improves 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, 1999–2000
Usual Medicare
Palliative care intervention
40
35.0
30
20
13.2
11.1
9.4
10
5.3
2.3
0.9
2.4
4.6
0.9
0
Home health
visits
Physician
office visits
ER visits
Hospital days
SNF days
Source: KP Study Brumley, R.D. et al. JAGS 2007; Diane Meir, Center to Advance Palliative Care
Hospice/Palliative Care Screening
1) Advanced life-limiting illnesses?
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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<200 or AIDS defining illness, progressive decline)
Other advanced disease (pulmonary hypertension, CAD, other)
2) Has the patient had progressive losses of Activities of Daily Living and/or a severe decline in functional status?
Yes / No
3) Does the patient demonstrate any of the following unmet needs?
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Guidance with pain and/or non-pain symptom management
Advance Care Planning/Advance Directives issues related to continuing health care needs
Guidance with healthcare decision-making
Bereavement Issues negatively impacting health status
Frequent hospitalization for advanced illness
If “Yes” to Questions 1 and 2: Patient/family would benefit from Hospice Consult.
If “Yes” to Questions 2 and 3: Patient/family would benefit from Palliative Care Consult.
Adopted from the Beth Israel Medical Center, New York ED Palliative Care Screening Tool; The Center to Advance Palliative
Care (CAPC) Website
Home Care Delivers Satisfied Patients
Would patients recommend the home health agency to friends &
family?
82%
82%
82%
81%
81%
80%
80%
79%
79%
79%
78%
78%
State
National
Patient Satisfaction Survey
How do patients rate the overall care from the home health agency?
85%
85%
85%
85%
85%
84%
84%
84%
84%
84%
84%
83%
State
National