The home health industry has gained a front-and-center seat at the table within payer and health system boardrooms. Yet at times, providers still feel like their value isn’t being fully recognized by one of the nation’s most important payers – the Medicare program, managed by the U.S. Centers for Medicare & Medicaid Services (CMS).
That idea is reflected in CMS attempting to cut home health payment rates for 2024 while permanently adjusting how the Patient-Driven Groupings Model (PDGM) reimburses providers, according to BAYADA Home Health Care CEO David Baiada.
In this Future in Focus interview, Home Health Care News catches up with Baiada to discuss the looming home health cuts and how industry stakeholders are ramping up their advocacy efforts to counter them. During the conversation, Baiada also touches on his company’s technology views and the ongoing labor shortage.
HHCN: To start, I’ll ask you to look back over the past few years to the very beginning of 2020. From then until now, how would you describe the overall progress home-based care has seen in the U.S. – and what are some of the best examples of that advancement?
Baiada: Our home health care industry, thanks in part to our heroic efforts during the COVID-19 pandemic, continues to receive increased attention and focus as a high-quality, low-cost and preferred setting of care.
This is creating important and more strategic dialogue in boardrooms and policy forums about the long-term value of home and community-based care programs — at least from the perspective of consumers and health systems.
What hasn’t kept up with that progress have been significant cuts in home health funding and now tightened restrictions with Medicaid and the pending 80/20 rule.
In what ways has your own organization advanced during this period?
We have advanced our precision and clarity on how best to double down on our corporate strengths and values.
We are strategically transforming toward a long-term vision, not only how we see the future of our own organization, but how we advocate for the future of the health care continuum. To get there, we’ve taken crucial steps to ensure our company will never be sold and have committed to a relentless focus on talent and culture.
Looking ahead, what is the single most important thing that needs to happen in order to further accelerate home-based care in the U.S., and why?
We need to address the funding crisis to ensure that we can keep up with inflation and invest in innovation, talent and career development.
Immediately, that means higher reimbursement rates. And it’s also going to take policymakers to invest in creative solutions that feed the pipeline of our health care workforce.
In your view, what are the top 2-3 ways that technology specifically has advanced home-based care in recent years?
Our digital and technology innovation priorities are focused predominantly on augmenting our ability to attract, engage, train and inspire the very best talent. Our product is people, and when you have the best people, you deliver the best services.
We invest in technology to transform candidate and employee experiences in areas such as communication, talent attraction and training. And we advocate for institutionalizing some of the lessons underlined by the pandemic, where we saw how technologies can advance home-based care’s influence on efficiency, quality and client satisfaction.
What emerging technology trend do you see disrupting home-based care most over the next 5 years, and why?
One of the emerging technologies I’m most excited about is augmented/virtual reality, specifically to transform the training of clinicians.
By simulating a home care setting, we are safely providing experiential opportunities for learning and practice that help clinicians become more skilled, confident, and prepared to think on their feet for the clinical, social and environmental variabilities of home-based care.
When we think about advancing home-based care, we can talk about moving the needle with a variety of key decision-makers and gatekeepers. Looking exclusively at the policy space, what are some home-based care advancements you’d like to see turn into reality?
Immigration reform is a critical opportunity to address the increasing imbalance between the need for home-based care and the available supply of clinicians and caregivers to provide the services.
We have to unlock new labor pools from abroad.
Workforce development should be a priority for state and federal governments because without it, we’ll continue to struggle to attract new talent.
We also need proactive policies to encourage home-based care options like modernizing the Medicare home health program, eliminating care gaps that revolve around payer sources rather than client needs and expanding hospital-at-home and Choose Home programs. There’s a huge opportunity there for savings, client satisfaction and better outcomes.
Then there’s also advancing home-based care and advocating on behalf of providers in the context of payers, including managed care. What degree of progress has the home-based care field made in communicating their value to payers, in your view?
I think there’s been light years of progress.
BAYADA has been one of the largest providers of home-based care to the managed care industry for over 25 years. And in the last five years, we’ve seen a significant acceleration in our engagement and strategic dialogue with the payer community.
Generally, as we conduct this interview in mid-2023, do you believe payers currently recognize the value of home-based care services? If they don’t, or if there’s still understanding that needs to happen, how are you and your organization contributing to those efforts?
While I think there’s significantly increased recognition of the value of home-based care, there are still significant hurdles in how to operationalize partnerships to realize that value. Payers are working hard to administer government-designed and heavily regulated insurance benefits and changing the clinical and payment models is complex and difficult work.
It just takes time – years and decades, not months and quarters.
Looking ahead again, what’s on your advocacy to-do list for the rest of 2023?
As a national provider of both federal and state-funded services, we have a lot of policy priorities. Importantly, the common thread is a focus on partnering with the government to advance payment and regulation in ways that ensure that we can attract, train and inspire the very best clinicians.
What trends, challenges or opportunities do you see helping – or hindering – the advancement of home-based care over the next 12 months?
Labor shortages — and the regulatory/payment policies that perpetuate those shortages — will continue to be the No. 1 obstacle in meeting the needs of the clients and families who rely on and deserve high-quality home-based care.
