New payment models are changing the way home care providers deliver care, but breaking away from the fee-for-service tradition can be a big challenge.
Improving care delivery will require technologies already in use today, such as telemedicine and remote patient monitoring, said Mike Johnson, Bayada's principal investigator for home care innovation. But it also includes more cutting-edge technology, such as risk prediction models that can help reduce hospitalizations and admissions.
Bayada provides home health, home care, hospice and behavioral health services in 22 states and seven countries.
For Johnson, data showing reductions in admissions and admissions when provided to payers, what he calls “enlightened providers,” is critical to helping evolve the home care industry's payment models.
Johnson spoke with Home Health Care News on the Disrupt podcast to discuss the need for unified data sets across the industry, how technology can benefit the workforce, and how the industry will transform over the next decade and beyond.
Below are excerpts from that conversation, edited for length and clarity.
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HHCN: What innovations currently excites you the most and how will they change the home care industry?
Johnson: Telemedicine and remote patient monitoring still have great utility. You need to make sure you are upholding the rules for telemedicine. Because telemedicine, even via video, can bring many benefits to people. And basically, we're expanding the workforce because we've eliminated driving. So I'm still really excited.
Risk prediction and algorithms continue to be where we can really gain insight, especially when it comes to artificial intelligence. We focus on risk prediction to reduce falls because we believe the downstream effects are increased hospitalizations and costs. We have made considerable progress in this regard and will eventually be able to apply it to all of our practices. When we talk to Medicaid payers who are under a lot of stress, if we can be proactive and show them ways that we can reduce not only readmissions but readmissions, that's going to be a conversation that they're interested in having.
And the last part is how do we reduce the time it takes for clinicians to complete documentation? I'm a clinician, so this is personal to me. The promise of EHRs is to improve quality. That's still up for debate, but I think it's certainly possible, and in some ways it is. They intended to make clinicians' lives easier, but they made ours difficult. There's more to document. It becomes difficult to interact with patients. If technology could step in and allow me to say something and have it transcribed directly into OASIS, that would be a game-changer. And it's scheduled to happen within the next year. Personally, as a clinician, that's very exciting. If I didn't have to do all the paperwork, I might go back and start treating patients again from time to time.
Are payers accepting the data shared by providers?
I think so. When I was a clinician, payers were the devil, or so it seemed, as far as I was concerned. And they are not correct. I got to know the people who were in the paying organizations, so they're doing the same thing that we are. They try to take care of their members. Yes, there are bad actors who make bad decisions and make payers the bad guys, and unfortunately, that exists in home health care as well.
However, two things tend to be limiting. One is their ability to give us their full attention. Remember, they are paying hospital bills and much more. Therefore, rounding errors may occur in some cases. So is it important enough for them to spend the time and energy to not only devise a new payment model, but also implement it?This is the second part, because systems are often built to pay for services. Paying per episode sounds easy, but it's not. In reality it's more complicated. Those are things we encounter. But if you can make a good enough argument that moving from piecework to one-time payment could reduce things like readmissions, and you can tie a dollar to that, you can get enough attention that at least people who are thinking ahead and trying to be proactive will work hard to figure out how to make that happen.
I call them enlightened providers, but there are actually quite a few providers out there who I think are enlightened and trying to do the right thing. Those are the people we should focus on. Because once we succeed there, we go to people who are perhaps less enlightened, or who are buried in other things. They will appreciate new solutions that seem to work.
What steps can providers take to move the industry away from a pay-as-you-go model?
When it comes to the industry as a whole, there is a unified dataset. The skilled nursing industry has datasets like this that accomplish two things. One is that it's a pool for industry-independent researchers to really look into this and provide great insight into what works and what doesn't. But the other thing it does is it allows organizations to benchmark. It helps you understand where you are now.
I'm using this as an opportunity to think about one thing we can do as individual providers who are listening to this and as an industry. Make sure your home is tidy. If we don't have the right systems in place to officially schedule, go home early, communicate between therapists, nurses, etc., then changing to a temporary payment system won't get us the results we want. Because Medicare-certified home health care in particular, and health care more broadly, is a team sport. We spent a lot of time building the infrastructure to ensure we had a proactive screening system beyond OASIS. We focus on risk prediction.
So all of this can help you improve your patient's symptoms right now, without changing your payment method. So do these things first. Then you'll be ready to actually reap the benefits of the payment method changes we believe will help.
I have been working with Bayada for 17 years. What trends will shape home care over the next 17 years?
I think we'll continue to see more participation from patients and their families, and I think that's a good thing. It will force us to work on our game, be transparent, etc. Fundamentally, I think we have an opportunity to change where care is delivered. The pressure on the health system will only increase as we now compete with them for bed capacity. Many people do not need to be in a hospital bed and can sleep perfectly in their own bed at home. If we could address the workforce issue, there would be more demand, but the population is not keeping up.
So I think there's going to be a huge influx of technology here to offset some of the workforce loss. The appearance changes greatly. As long as we make sure that people are at the center: patients, their families, and the clinicians in the clinics who are trying to support them, we'll be fine. If we left decisions to machines, we would all be in trouble. I'm hopeful and a little confident that we won't fall into that trap. Because at the end of the day, medicine is a business of humans taking care of humans. AI can never replace it. Can they augment it? Indeed, it can actually make us superhuman. So I'm looking forward to seeing what that turns out to be. As technology continues to evolve, expectations for input and access to home services will continue to rise. And ultimately, I would like to believe that more clinicians will feel that they are truly committed to caring for people holistically.
