The home health care industry has a promising future: Americans are living longer than ever, and the majority prefer to age in place, receiving in-home services.
But the evolving health care landscape is not without challenges, and many providers say they struggle with high employee turnover, a confusing reimbursement system and lack of transparency between hospitals and in-home caregivers. Yet, those problems also present opportunities for innovation and new ways of using technology, says Dr. Steven Landers, president and CEO of the Visiting Nurse Association Health Group, Inc.
“There’s never been a bigger opportunity for helping older Americans succeed at home and in the community,” Landers says. “But, payment models and the health care framework are changing. It’s a dynamic time for home health care providers.”
The Red Bank, N.J.-based nonprofit home health care organization is one of the nation’s largest Medicare-certified providers of in-home care, private care, hospice, palliative care and more.
“We are at the start of our Sputnik moment for aging from a demographic standpoint in this country,” says Landers. “We have the greatest eldercare challenge that has incredible implications for our economy — we need a better strategy for home care and aging in place.”
Landers spoke with Home Health Care News about the challenges and opportunities in the rapidly shifting home care landscape and the promise of technology and innovation in the space.
HHCN: What are some of the challenges and opportunities that are unique to those in the nonprofit home health care space?
SL: Home care providers broadly have a range of challenges and opportunities. One thing that’s unique among many nonprofits is that they have a portfolio of programs and services that may not have a normal business model — meaning they require philanthropic funding or cost shifting.
For example, we do mobile outreach nurse visits in boarding homes, homeless shelters and provide other public health services. Those services require grants. At the same time, there’s a tightening of the belt in Medicare and Medicaid funding. To manage, we need other funding streams, other than cost shifting, because of the direction where Medicare and Medicaid policy is going.
HHCN: What about for the broader home health industry?
SL: If you’re a provider, and you can help high risk older patients age in place — there’s never been more opportunity because there’s a need to find ways to help high risk populations. But you have to be able to bring and demonstrate the outcomes.
There are reasons why things fall apart in the community that are sometimes hard to control. [Patients] might not have the basic social support they need to be healthy. There might be physical or mental health issues among the individuals or their [family] caregivers. The other challenge is in order to make an impact on outcome you need to be able to have a measurement of the outcome and data transparency. Home care providers are not always given full access to data relating to the patients they take care of. Providers are not always sure if the payor is experiencing a lower cost. We don’t know if trends are going our way or not in the big picture.
HHCN: What can be done to improve transparency?
SL: Data sharing from payors is important. There has not been widespread data sharing about how home health is impacting the payor outcomes at the provider level. There have been some pilots and demonstrator relationships, but more broadly, [data] seems to rest in managed care, Accountable Care Organizations (ACOs) — not necessarily with the provider. That’s a barrier to being able to prove you’re doing better.
If cost is king, and you don’t know what the costs are that’s very difficult. You can look at your own hospital readmission rate and determine if you’ve had a good outcome, but that’s nothing compared to knowing the actual cost of care for patients and when your services and programs are helping to lower that or not.
In addition, with state-level Medicaid reforms, you see the expansion of managed long-term care. That’s a real shift for home care providers. Home health agencies not only need their own staff to change, they need to change how physicians interacting with them, regarding paperwork and regulatory hurdles. Doctors need to be educated.
HHCN: How will technology innovations play a role in the home health space?
SL: There is incredible potential for mobile and digital technology video conferencing, and for robotics to make an impact on care in the home. The progress, just within the last few years, of bandwidth in patients’ homes, usability of consumer electronics and other developments open us up for more connected health opportunities.
HHCN: Could technological advancements replace the need for home care workers?
SL: There’s nothing that is going to replace in-home care — the impact of the human presence, caring and compassion that is conveyed by home care workers. Technology will help us position people to do what they’re best at, so higher level skills become more important.
If there’s something that can be done through technology that is relatively less complicated, it will free up the human caregivers to spend more of their time on the important stuff, the high level problem solving that deals with the most urgent situations, which also cause the most cost.
In America, we’re going from 35 million older Americans in 2000 to more than 70 million in 2030. We can’t afford to have very precious skilled human caregivers doing marginal tasks that can be done another way. We’re going to need to figure out how technology can help.
Written by Cassandra Dowell