Today’s cutting-edge technology solutions can do many innovative things: They can process massive amounts of code, for example, they can learn and optimize driving routes, and they can help perform quality control measures for large scale manufacturers.
In health care, artificial intelligence combined with machine learning and a shift toward cloud-based technologies is producing groundbreaking advancements such as predicting health outcomes, managing remote patient monitoring and optimizing staffing processes to best utilize clinicians’ licenses and save precious administrative time.
As home-base care providers become more comfortable with these health care applications, there is another critical area where tomorrow’s technology will benefit them in immeasurable ways: payments.
“The primary goal of value-based payment is to reduce the spend rate of Medicare,” says Tammy Ross, Executive Vice President of Professional Services for Axxess. “As we look at the Medicare spend rate, cost efficiency is a big driver for AI.”
The Rise of Value-Based Care
More than half of Medicare beneficiaries, or 54%, today are enrolled in Medicare Advantage plans, according to the Kaiser Family Foundation (KFF). This figure has risen steadily in recent years from a penetration rate of just 19% in 2007 to surpassing the 50% mark in 2023. The average beneficiary has access to twice as many programs today as were available in 2018, according to the KFF, and the number of beneficiaries is expected to continue growing.
With specific programs under the Centers for Medicare and Medicaid Services incentivizing providers to achieve quality outcomes for services across care settings, such as skilled nursing and home health, the industry has adapted to a world in which value is awarded to quality outcomes and will continue to operate in this environment.
“It may be value through reduction of hospitalization or improved outcomes for functional scores,” Ross says. “… all of those things lead to increased health care costs. We want to drive down that cost.”
Value-Based Care and Technology
Technology is supporting care outcomes in several ways, ultimately translating into value:
- Patient assessment, monitoring and decision-making
- Reducing administrative burden
- Data analytics and reporting
Patient assessment and monitoring: Clinical support systems through electronic health record technology enable nurses to identify changes in health care patterns. This may be through telehealth wearables or other remote devices such as iPads where a patient can verbally or visually report their condition. Today’s innovative EHRs can then analyze metrics such as blood sugars for any outliers and can report them back to the clinician.
“Those exacerbations are changes in conditions for patients,” Ross says. “These could lead to falls, to emergency room encounters, hospitalizations or worse. But rapid intervention and speed to care is going to greatly impact the outcome, powered by AI.”
Reducing administrative burden: Today’s AI solutions are not only saving time for clinicians who previously had to enter patient information manually, but they are reducing errors as well, which leads to better accuracy and in turn, better care.
Data analytics and reporting: Today’s technology solutions, powered by artificial intelligence, are collecting data from multiple sources such as pharmacies, hospitals, physicians’ offices and others, then supporting clinicians by helping them create individualized care plans specifically designed to drive positive outcomes.
Through Axxess’ EHR platform, clinicians are able to take the information AI assimilates and gain a risk score for hospitalization that explains how much a patient is at risk and how to mitigate that risk.
“This comes through our Pathways and gives the nurses best practices to mitigate the risk of that patient going to the hospital,” Ross says.
The Future of Tech and Value-Based Care
With the onset of rapidly evolving technology including machine learning and generative AI solutions, the health care industry is poised to change.
“I think AI is going to reinvent the health care industry overall,” Ross says. “However, in the next five years, we are going to have to catch up to the technology.”
Regulations such as HIPAA may consider changes, Ross notes, to enable data sharing in the interest of improved outcomes. This shift includes reimbursement as well.
“We’re going to have to rethink our reimbursement models,” she says. “The future of AI in home-based care, I think, is limitless.”
Axxess is a comprehensive platform built by home-based care experts to empower home health professionals in delivering quality care. To learn how Axxess is partnering with operators to help them make the greatest impact on all stakeholders through actionable data, visit https://www.axxess.com/home-health-software/.