The ‘Dream’ Scenario Of Combining Home Health, Home Care To Unlock Value-Based Care

One of the publicity issues home-based care faces is that most people don’t even understand the difference between home health care and home care, much to the chagrin of industry veterans in both sectors. But in the future, those same leaders are bullish on the merging of those two types of care.

Home care and home health care are separate services, yes. But together, could they unlock a doorway to the world of value-based care? Lots of organizations already provide both services, and referrals between those segments occur.

Increasingly, though, providers believe that home care and home health will end up supplementing each other. Each care type can augment the other, they believe. Particularly for those that are chronically ill.

Griswold CEO Mike Slupecki first brought this up to me at HHCN’s Home Care Conference years back. Griswold was a personal care provider, looking to expand its scope and value.

After all, Slupecki was formerly at Interim HealthCare, which provides home health and home care services on a wide scale.

“The way we talk to them is by having them introduce us to their clients,” Slupecki said last year. “We’re going to help them on their scores, because they’re impacted by client satisfaction scores. They’re impacted by acute care hospitalizations or ER visits. We feel like we can be the eyes and the ears.”

More momentum has picked up around this idea. Leaders may have known for some time that the concept works, but there are also more opportunities to demonstrate the value of the crossover than ever before.

That’s the topic of this week’s members-only, exclusive HHCN+ Update.

Putting the two together

In recent years, home-based care companies have taken divergent paths when it comes to diversification of service lines. Some have added service lines, looking to provide the full continuum in the home. Others have offloaded to become hyper-focused on just home health, or just home care.

For the purpose of this conversation, however, that doesn’t matter.

Organizations with home care and home health capabilities can make this happen in house. Those with one or the other can partner with other companies who can do what they can’t on their own.

Addus HomeCare Corp. (Nasdaq: ADUS) is a good example of this. The company has a small home health segment, but is focused on growing it. That’s because it feels like home health is the backbone to its value-based care strategy.

“When we look at home health, we don’t want to get caught up in the fact that the next year or two may be a little tough,” Addus CEO Dirk Allison said last year. “We think long term, and it’s a really good part of the business that we need to have at Addus.”

That’s why, amid an M&A downturn, Addus acquired assets like Tennessee Quality Care, which is a large home health asset.

That same day, Addus COO Brad Bickham said that health plans are “very bullish” on that model, which is home health being layered on top of personal care in certain markets.

Choice Health at Home CEO David Jackson said that, no matter how much the company expanded service lines in the future, home health would remain the focus – for the same value-based reasons.

“A quality home health asset, I think, is the premium in post-acute care,” he told me in September.

Value-based goldmine

Home care can come in before home health care, after home health care, or in both instances. Whatever the approach, Addus believes there’s plenty of value to it.

“We really believe we’re at the beginning of being able to sit down and talk to some of the payers that are excited about value-based care, showing them what personal care along with home health can do,” Allison said.

Amy Harrison, the president of Vanderbilt Home Care Services, recently explained to me her aspirations for this type of care setup.

“I would love to have a chronic disease management program where we can combine forces and utilize nursing therapy, but also hourly care,” she said. “At least those first few days when these high-risk patients come home from the hospital. And I think that is my dream, just to really mold our services together and get that reimbursable. That’s going to keep these folks out of the hospital. That supportive care and the interdisciplinary team being intermittent and hourly together.”

Currently, traditional Medicare is not set up to reimburse such arrangements. But even in traditional Medicare, home care providers could help home health providers in their value-based setups – and in metrics under the Home Health Value-Based Purchasing (HHVBP) Model.

But the real opportunity lies within managed care.

Health plans willing to bet on home health and home care together have the ability to significantly reduce readmissions and enhance their medical loss ratios (MLR). 

“There will be an ongoing focus on better integrating clinical care with home care services and supports,” Help at Home President Tim O’Rourke recently told Home Health Care News. “Identifying ways to connect home care with health care will help address gaps in care by focusing on social determinants of health (SDoH) and other health-related social needs. Additionally, communities must prioritize a comprehensive range of aging supports, such as affordable housing, access to nutrition, pharmacy services and transportation, to create environments that enable older adults to live healthier lives in their own homes.”