In prior articles, I have talked about something new that is coming with the Affordable Care Act (health care reform) and accompanying changes to Medicare practices. That is Accountable Care Organizations. In that posting, I talked about the notion of a bundled approach to care, by a group of providers working for the benefit of the patient, rather than a number of individual service providers.
In the latest edition of The Remington Report, Lisa Remington, one of the leading authorities in health care strategy and analysis, talks about an incredibly important topic, in my view, which is the value of home care in the move to Accountable Care Organizations.
Ms. Remington points out that,
Unlike the traditional HMO model, that ACOs have been compared to, an ACO has a majority of its board made up of physicians. It is a coordinated group of providers with its base made up of
primary care physicians. Hospitals are also a part of the model and arguably the most dominate player. Additionally, the ACO itself can determine other providers and suppliers necessary to fulfill its purpose. CMS is being very flexible in allowing the
early participants to be creative in their structures and how each will participate in any gain sharing opportunities.
In other words, the Accountable Care Organization is not really one company. It defines itself, potentially from multiple companies and agencies and clinical groups. Moreover, the ACO has the flexibility to look beyond the traditional boundaries of hospital and physician to determine who “has a seat at the table.”
Having high quality home care agencies seated at that ACO table is a major change in strategy and one that has great potential for improvement in both quality and cost of care – the two goals of the Affordable Care Act.
Why and how can home care agencies make a major contribution? As Ms. Remington points out,
When we look at patients coming out of hospitals nationwide prior to October 1, 2012 we find that 76% on average received no post acute follow up at all. MedPAC states that 75% of readmissions are preventable at a cost savings of $12 billion
How can those readmissions be prevented? One way is to ensure that those patients that need support at home, after hospital discharge, get the support that will prevent a recurrence of the original problem, or a worsening of their condition, post-discharge. Unfortunately, currently, only 15% of discharged patients are referred to home health agencies and even fewer to non-clinical home care agencies. That statistic needs to change, if home care is to have the positive impact needed.
As Ms. Remington fairly bluntly puts it,
Today, hospitals and almost all the ACO’s are treating the process of transition between hospital and home as a new concept. Hospitals have clearly acknowledged that the home setting is outside their control, and what the numbers prove is that hospitals
are not the best determinate for who, what, when, why or where post acute care should be implemented. Post acute care is not a core competency of the hospital. It is, however, a core competency of home care agencies.
There you have the crux of the problem and a big part of the solution, not just for unnecessary readmissions, but for critically needed improvements to the health care provided — and therefore, the outcomes achieved.
There is much more to say on this topic — and on Ms. Remington’s analysis — soon. In the meantime, your thoughts are welcome.
Best wishes. Bert