Home Care Gets a New Place in the Medical Neighborhood

 


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Collaboration with home care providers allows family physicians to extend their influence over patient outcomes and health care costs.

Fam Pract Manag. 2016 Jul-Aug;23(4):18-22.

Author disclosures: no relevant financial affiliations disclosed.

Family physicians treating older patients with chronic and disabling comorbidities who cannot leave home without considerable effort have the opportunity to establish collaborative partnerships with an increasingly diverse array of home care providers. By forming working relationships with these providers, physicians can help their patients achieve positive health outcomes in ways that will also reduce overall health care costs.

As Medicare and other payers shift to value-based payment models, the need for collaboration along the care continuum will be greater than ever. Increasingly, payments to physicians will be linked to their ability to influence positive health outcomes through the resources of multidisciplinary, collaborative teams that have aligned financial incentives through shared savings and bundled payment programs. (See “Reducing the cost of health care.”)

New home care models now being regularly introduced by health care systems, payers, and managed care organizations are designed to provide continuous, coordinated medical care that taps into value-based revenue streams. These new models expand on traditional models that provide home care – sometimes uncoordinated – for only a limited period of time while relying heavily on transporting patients to care facilities. The new models have several elements in common, namely effective care transitions, multidisciplinary teams, an identifiable care coordinator, the use of home-based technology, patient and family engagement, palliative and hospice care, and quality reporting. And, very importantly, these models align the financial incentives of the professionals working on behalf of the patient, giving them good reason to collaborate frequently and effectively. Family physicians will increasingly find themselves with new and growing reasons to collaborate with the home care providers in their medical neighborhoods.

REDUCING THE COST OF HEALTH CARE

Health care economists are relying heavily on new delivery models that align financial incentives across the care continuum to rein in national health care costs, which are particularly high at the end of life:

  • About a quarter of the $500 billion-plus Medicare spends goes to care in the last year of life.1

  • 1 percent of the U.S. population accounts for about 23 percent of overall health care spending.2

  • 5 percent of the population accounts for 50 percent of overall health care spending.2


REFERENCES

1. Riley GF, Lubitz JD. Long-term trends in Medicare payments in the last year of life. Health Serv Res. 2010;45(2):565-576.

2. National Institute for Health Care Management Foundation. Health care's 1%: the extreme concentration of U.S. health spending. November 2014. http://bit.ly/293z143. Accessed May 24, 2016

About the Authors

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Margherita Labson is the executive director of The Joint Commission's Home Care Accreditation Program in Oakbrook Terrace, Ill....

Dr. Wyatt is the patient safety officer and medical director in The Joint Commission's Division of Healthcare Improvement.

Author disclosures: no relevant financial affiliations disclosed.

 

References

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1. Health & Medicine Policy Research Group. The Chicago Forum for Justice in Health Policy: improving health by reaching patients in the home. Aug. 28, 2015. http://hmprg.org/Events/HealthcareinHomesComms. Accessed May 24, 2016....

2. Institute of Medicine and National Research Council. The Future of Home Health Care: Workshop Summary. Washington, DC: The National Academies Press. 2015.

3. Centers for Medicare & Medicaid Services. Affordable Care Act payment model saves more than $25 million in first performance year. June 18, 2015. http://go.cms.gov/1XnXAdM. Accessed May 24, 2016.

4. Ornstein KA, Leff B, Covinsky KE, et al. Epidemiology of the homebound population in the United States [published correction appers in JAMA Intern Med. 2015;175(8):1426.] JAMA Intern Med. 2015;175(7):1180–1186.

5. Riley GF, Lubitz JD. Long-term trends in Medicare payments in the last year of life. Health Serv Res. 2010;45(2):565-576.

6. National Institute for Health Care Management Foundation. Health care's 1%: the extreme concentration of U.S. health spending. November 2014. http://bit.ly/293z143. Accessed May 24, 2016.


 

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