1. Cameron, Joy Mishell MPP

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The home care industry is fraught with new requirements and limitations being placed on the fee-for-service end, whereas the Triple Aim moves the overall healthcare market toward value-based purchasing, capitated models, bundles, and managed care. New quality requirements and analytics, true interoperability, and being able to make data-based value propositions for the high-quality services you provide are all going to be basic requirements of the home care industry. Agencies have to ask themselves now where they want to be in the next few years.


Currently, there are Visiting Nurses Associations of America (VNAA) members who are partnering in a variety of alternative payment and delivery programs: Medicaid Managed Long Term Care; CMMI Model Three Bundled Payments for Care Improvement; Accountable Care Organizations; and a CMMI Innovation Grant programs focused on advanced illness and palliative care. All of them are experiencing or experienced significant quality improvements and cost savings.


Medicaid Managed Long Term Care (MLTC)

Visiting Nurse Association (VNA) of Central New York is partnering with two Independent Practice Associations in the delivery of care management services across all settings in New York State's Medicaid MLTC program. Although they have increased their preventive service usage in the care they manage, their hospitalization percentage for this high-need population is well under the state benchmark of 15% utilization for all quarters. They are also successfully managing the majority of the population in their home and out of higher-costing care settings.


CMMI Model Three Bundled Payments for Care Improvement (BCPI)

Hartford HealthCare at Home is an integral part of Hartford HealthCare's (BCPI) demonstration that is reducing skilled nursing facility usage and shifting to primarily home health-based recovery for total hip and total knee replacements. This program has resulted in improved quality outcomes evidenced by lower hospital readmissions and emergency department visits while saving approximately $4,000 per patient.


Partnering With Accountable Care Organizations (ACOs)

Concord Regional VNA is partnering with a New Hampshire accountable care organization, Concord/Elliot ACO, to improve care, the patient experience, and the health of the community, and reduce the cost of healthcare. Through the Medicare Shared Savings Program, Concord Regional VNA and the ACO have specifically focused on reducing rehospitalizations of at-risk patients by providing Medicare fee-for-service beneficiaries with high-quality service and care, while reducing the growth in Medicare expenditures through enhanced care coordination.


CLAIM: Comprehensive Longitudinal Advanced Illness Management

Penn Home Care and Hospice Services coordinated with Penn Medicine to develop and implement the CLAIM program. The CLAIM program provided in-home support to certain qualifying patients with advanced cancer. The goals of the program included improving the quality of life, avoiding unnecessary hospitalizations, and managing symptoms.


The results of the CLAIM program saw a rise of 30% in patients who feel their pain is controlled (82%), an increase of 60% for patients who have documented their care goals (95%), and a reduction in costs of approximately $101 per patient per day. The accumulated savings over the 3-year term of the demonstration was almost $2.8M.


When taking your first steps toward new ways of partnering and delivering care-how are you and your agency going to choose what investments in innovation to make?


VNAA's Center for Value-based Transformation is working with agencies and their boards to walk through the strengths of agencies, needs in the areas you serve, and ways to sustainability partner and innovate. This strategic planning is helping participating agencies and their boards decide who they might partner with, how to best achieve that partnership, and what role the agency wants to have in their communities. It is vital to begin these conversations, so that you and your agency can contend with the shift in the healthcare marketplace and you establish your place in it.


More Americans Cared for at Home, But This Takes a Toll on Family Members, Researchers Say

HealthDay News: Older Americans with chronic health problems are opting to live at home, relying on help from family, paid caregivers, or friends, a new study finds. In 2012, half of seniors with a disability had some type of home healthcare, an increase from 42% in 1998, University of Michigan researchers found. "The majority of seniors would prefer to stay at home rather than go to a nursing home," said Dr. R. Sean Morrison, past president of the American Academy of Hospice and Palliative Medicine. But the unintended consequence of being cared for at home is the strain it puts on caregivers, added Morrison. "Research has shown that 40 percent [of caregivers] spend 20 or more hours a week caring for an older relative-that's half of a full-time job," Morrison said. Besides lost work and income, this can lead to depression and other health issues for caregivers, he said. "We can't say we want more care in the home, less care in institutions, without providing our families the resources that allow them to care for a seriously ill older relative at home," he said. If rates from this Michigan study are representative of the nation as a whole, more than 3.1 million more American seniors had home help in 2012 than in 1998, said the study's lead researcher, Dr. Claire Ankuda. For the study, Ankuda and her colleagues collected data on nearly 5,200 people 55 and older who took part in the Health and Retirement Study by the University of Michigan Institute for Social Research. All had one or more disabling conditions. People with more than a high school education and above-average net worth accounted for most of the increase in use of paid home healthcare aides, the researchers found. This suggests a growing disparity in paid care for disabled seniors. It might also indicate a trend to aging at home, even among those who might be able to afford a nursing home. Still, about two-thirds of men and 45% of women had no caregiving help, despite some trouble with basic tasks such as making meals, getting dressed, going to the bathroom, or managing their medications. The report was published in the Journal of the American Medical Association.

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