Providing home health services helps health systems and hospitals manage patient outcomes after hospital discharge.
Many health systems and hospitals across the country are either fine-tuning their existing home health capabilities or integrating new home health capabilities into their organizations. The reason why?
Home health services can play a key role in containing cost of care. For example, hospitals and health systems can deploy home health services to avoid financial penalties under Medicare's Hospital Readmission Reduction Program for a half-dozen conditions including heart attack, pneumonia, and coronary artery bypass graft. Beyond the HRRP penalties, readmissions increase total cost of care.
Dan Dietz, president and CEO of Milford, Ohio–based CHI Health at Home, says providing home health services can drive several clinical and financial benefits at health systems.
"We're providing home health, hospice, home infusion, and home respiratory care. All of those services have the ability to help health systems improve the quality of health for their patients, reduce readmissions, and decrease length of stay," he says.
CHI Health at Home also provides services that help reduce utilization of healthcare services, Dietz says. "We have a program where we do emergency department avoidance. So, if a patient shows up at the ED, we will admit directly from the ED into home health, and hopefully avoid a hospital admission."
There are several recent examples of CHI Health at Home generating positive results for its corporate parent, Chicago-based CommonSpirit Health:
- Quality outcome: In data collected from April 2017 to March 2018, improved medication management for CHI Health at Home was 78.6% compared to the Centers for Medicare & Medicaid Services national average of 66.7%.
- Hospital readmissions: CHI Health at Home's Avoiding Re-hospitalization through Care at Home (ARCH) program uses a predictive algorithm to identify and place patients into the ARCH program based on the risk of readmission once patients are receiving home health services. In 2018, ARCH reduced the 30-day hospital readmission rate from 14.3% to 13.3%.
- Length of stay: CHI has helped several hospitals reduce length of stay through its Care Coordination Model. From May 2016 to December 2017, Jewish Hospital in Louisville, Kentucky, achieved a 4% decrease in length of stay through the care coordination program.
"We're tracking all sorts of data points—quality outcomes, patient satisfaction, patient engagement, as well as operational performance measures. Eighty percent of our locations have four-star ratings or greater with the Centers for Medicare & Medicaid Services. We currently have three locations within our organization that are at five stars, and none are below three-and-a-half stars," Dietz says.
CommonSpirit was formed earlier this year in a merger of Catholic Health Initiatives and Dignity Health.
At health systems, there are two primary models for providing home health services, he says. "If you're going to do this right, you either integrate fully with a health system or health systems develop a narrow network of home health providers."
1. Wholly owned approach
The full integration model helps health systems harness data, Dietz says.
"We became part of Catholic Health Initiatives in 2010. We brought on the individual markets to a national platform; so, we have one EMR. We can track every location for quality results, patient satisfaction, growth, and patient experience. We can scorecard those metrics across our entire footprint."
Capturing the benefits of scale are another advantage of the full integration model, he says.
"We believe in standardization—looking at best practices. As we have brought organizations onto our platform such as our 10 health system partners, we have adopted new best practices and extended them across the entire platform. We benefit from the size and scale in program development and clinical programs. Our scale also allows us to have a lot of specialty programs—if we were in one market, we would not have the ability to develop those programs," Dietz says.
For health systems, scale is an essential element for success in providing home health services, he says.
"There is value in the consolidation that we are seeing in the home health space across the market. Some of the benefits come from having a larger home health organization. If a health system just goes out and acquires a local homecare provider, they will eventually have to look for a larger partner."
Attaining large home health scale enables health systems to maximize home health capabilities, Dietz says.
"CHI Health at Home could not be doing the things that we are doing if we were only in one market. I might be able to pull off half of our activities—whether it's the clinical programs, or our expertise, or folks looking at data to help us develop solutions for health systems. There is value to scale in this business."
2. Narrow network approach
Establishing a narrow network of home health providers can work effectively at health systems, Dietz says.
"If a health system is not going to wholly own or partner with a home health organization on a formal basis, the second-best alternative is developing a narrow network of postacute care providers in which you can set some standards. The standards can be quality outcomes or how quickly patients are admitted to home care."
These narrow networks are mutually beneficial, he says.
"Home health providers are willing to adhere to requirements in order to be identified as a preferred vendor for a health system. When we talk with prospective health systems, the first question they typically will ask is about our quality scores."
Home health market evolution
The evolving healthcare market is putting a premium on home health services, he says.
"In the past two years, we have seen a much greater focus on home-based services and the importance of them. We have partnership programs with health systems outside of CommonSpirit. We are getting a lot more inquiries about partnerships because of executives seeing the value that home health, hospice, home infusion, and home respiratory care can bring."
New payment models are a primary driver of home health growth, Dietz says.
"It started with the development of accountable care organizations. You're seeing it with bundled payment models in the value that home services can bring. There's much greater focus on how to avoid an admission to a hospital. Home health can play a significant role to move that needle."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Home health services can play a significant role in limiting hospital readmissions.
At health systems, there are two primary approaches to developing a thriving home health capability: a wholly owned strategy or narrow networks.
Health systems should strive for scale in their home health capabilities.