Charting the Course for the Future of Home Health

Guest post by Teresa Lee, JD, MPH, Executive Director of the Alliance for Home Health Quality and Innovation

teresa lee

Change is coming in home health care, and the healthcare system at large.

That was the catalyst of discussion at the Institute of Medicine (IOM) and National Research Council (NRC) “The Future of Home Health Care: A Workshop” held last fall in Washington, DC. Stakeholders from across the care spectrum, including academia, providers, consumers, clinicians, and more came together to discuss the current state of home health care in America and the challenges it faces as it evolves to handle an ever-growing patient population.

In March, the IOM released the workshop summary, a comprehensive overview of the two-day conversation. The workshop summary is available through the Alliance for Home Health Quality and Innovation’s (the “Alliance”) website here, while complete workshop materials are available through the IOM. The workshop is part of the Alliance’s Future of Home Health Project, outlined on HHQI’s blog.

The key takeaways and themes from the workshop and summary were:

  • Health care needs to shift towards home- and community-based care.
  • New models of care delivery are making good use of home health in achieving the Triple Aim.
  • Policy and payment reforms are needed to drive new models of delivery.
  • Investment in training of the home health workforce is needed to enhance care coordination and efficiency.
  • Technology will enable the future of home health care delivery.
  • A focus on identifying quality and outcomes measures will guide progress toward the Triple Aim and truly person-centered health care.

Shift To the Home

As the conversation progressed, it became clearer that we’re at a crossroads in the American healthcare system, one that requires fervent discussions and swift action. The shift in care toward the community, with the home acting as critical locus of care, will help ease the incredible strain the healthcare system will undergo with an aging population who will continue to live longer.

New Models of Payment and Care

The new models of payment and health care delivery may offer a good first glimpse at a cost-effective, high-quality healthcare system for the future. These include: accountable care organizations, bundled payment arrangements, advanced illness management, home-based primary care, and more. These models are making good use of home health and home-based care as a means to achieve the Triple Aim of improved population health, improved patient experience, and lower per capita cost of care.

Optimizing the Home Health Workforce

In order to successfully employ new models of care, considerations regarding the current home health workforce are needed. Better coordination of care across the care team, including with patients and caregivers, will help facilitate optimal care in the home. Included in this is the need to train patients and caregivers in self-care.

Driving Forward with Technology

To enable the future use of the home as a critical locus of care, technology will need to play a key role. Mobile health, health information technology, remote monitoring, telemedicine, independent living, and point of care technologies will enable more, and more sophisticated, care to be provided in the home. These technologies will allow us to shift the setting of care towards the home and community.

Setting the Tone Through Quality

Central to success of the future care delivery system, however it may look, is the development of quality and outcome measures appropriate for an aging population. Measures need to focus on both chronic condition management, and rehabilitation and stabilization of function.

Where Next?

The workshop and summary sparked a much-needed conversation on the role of home health in the future care delivery system, but much more is needed. As a sponsor of the workshop, the Alliance set out to better understand the current role of home health and what is needed to be a valued participant in future models. Building on the themes of the workshop, the Alliance held a symposium in January 2015, and will be completing a research-based strategic framework in the first quarter of 2016.

The workshop summary serves as an excellent characterization of where we are and some of the innovative approaches being taken to care deliver health care in the home and community. We need to take what we learned in the workshop and develop a concrete strategic framework for the future of home health care. This will enable us to transform examples, ideas, and themes into practice that will foster an efficient and sustainable healthcare system for the growing numbers of older Americans.

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