The story is told of the new CEO of a drill bit company, a neophyte to drilling & the oil industry. The new Chief Executive spent an entire week listening intently to the top people in his new company. They explained their roles, the latest technologies, new diamond bits, other configurations and composites for the bits used in drilling, geological implications of the types of bits used, and more. At the end of the week he addressed the entire group, commending the expertise, experience and teamwork that had made them the top drill bit company in the world. Then he offered them a challenge. “I’m thankful that our performance with drill bits got this company to the top. But to stay on top I would challenge you to consider that over time, the actual product we deliver is not the drill bit, but the hole that gets to the oil and gas deep down in the earth.”
Would home health providers be wise to ask ourselves a similar question? What is the actual product we deliver as Medicare home health providers? Medicare home health’s skilled care model has been our ‘stock and trade’, ‘bread and butter’, and the ‘one what brung (sp) us to the dance’. Just as drill bits are the product for the company noted above, wound care, intravenous therapy, pain management, and patient assessment and teaching have been part of the skilled care, Medicare model. But what are the real products or services of the home health provider?
First, we keep people out of hospitals and other institutions. Studies have shown that those without care at home are re-hospitalized at a higher rate than those who have home health. We help to make the hand-off from hospital to home smoother. Lab work in the initial weeks, teaching about new medications, and assuring teaching about disease processes is done all help keep people at home.
Second, we prevent people from being hospitalized at all. Clinically sound evaluation and teaching of medications, diagnoses, treatments, diet, and use of equipment help patients to avoid the emergency room. Caring for chronic disease is about teaching, evaluating, changing behaviors, and getting patients and caregivers to buy into the process as partners. When done well care at home helps patients to achieve a stable condition as they live with their chronic disease.
Third, we are certainly on the verge of being the provider of wellness and prevention that health think-tanks have begged for over the past thirty years. Am example is the Nurse Family Partnership (NFP) of the Pew Center on the States is an example, promoting home visits by a nurse to new expectant families. “It’s more important than ever,” said Melanie Bronfin, J.D., public policy analyst at the Tulane University School of Medicine. “NFP is a proven effective program. As money is tight, people want to invest in things we know work. Rigorously evaluated, NFP is proven to yield returns on investments of up to $5.70 per taxpayer dollar spent. The program saves money by reducing childhood injuries, increasing women’s education, employment and self-sufficiency, and improving children’s school readiness.”
NFP is an example of the opportunity that abounds for home health in the explosion of various care models, pilots, and demonstrations that all involve care in the home setting. PPACA is filled with projects and dollars for care transitions, chronic care management, health coaching, the medical home, bundling of post acute care, the CLASS Act aimed at non-skilled community based supports and services, the Independence at Home Act aimed at the complex chronically ill, family caregiver support, and much more.
$10 Billion to the Centers for Medicare and Medicaid Innovation
Finally, the Gerson Lerman Group, a network of experts in various professions around the world that watches industry and various world markets writes, “The Centers for Medicare and Medicaid Innovation 9CMI) I has a $10 billion budget through 2019. This allows the CMS to build the capacity necessary to management the program effectively and to pay for services such as care coordination that aren’t covered by traditional Medicare. This will also support activities such as electronic data sharing, performance measurement and quality improvement at participating health care systems. Companies poised to take advantage of the operation of the CMI include:
1. Premier;
2. General Electric;
3. Accenture;
4. IBM;
5. Microsoft;
6. Google;
7. Dell;
8. Medco;
9. McKesson; and
10. CSC. ”
In closing, my nursing bias tells me that the value of the skill set of the home care professional is tailor made for today’s health care transformation. Chronic care, care transitions, care of the complex chronically ill, and every area mentioned above requires solid clinical care in the home. We in home care are positioned to benefit from these change.
If and when that drill bit company invents new technology, maybe a laser, to make the hole that gets to the oil and gas deep in the earth, they will have changed the drilling industry forever. Is PPACA the vehicle that provides home care such a transformational opportunity? PPACA is not perfect and will likely change some in the coming years. It will certainly test our mettle as providers work to adapt to tightened reimbursement and increased scrutiny. Politics, newly elected officials, and perhaps a new administration in 2012 will all likely play a part in amending this legislation. But with care at home an absolute must in most of the areas of innovation noted above, many home health providers will find PPACA to be an opportunity for them to be part of the evolution of health care at home. The challenge awaits.
Warren Hebert, RN, BSN, CAE
HomeCare Association of Louisiana
