The home care industry is plagued by regulatory, management, and staffing challenges. But Luke Rutledge, president of HomeCare Homebase, says the most serious challenge facing health care providers is the rapid rise of Medicare Advantage (MA).
According to data from HomeCare Homebase, MA is the primary source of payment for home care services. To continue to withstand this surge, providers must embrace new tools like ambient listening and data automation and rethink traditional operating models.
“The reason this is so important is that even with all the cuts, there is a 38% difference between what Medicare pays and what Medicare Advantage pays,” Rutledge told Home Health Care News. “That's one of the things that's keeping people up at night. As this bar continues to rise on the Medicare Advantage side, people are trying to figure out how to close that 38% gap.”
Dallas-based Homecare Homebase is one of the largest home care technology and management services companies.
Rutledge said technology is key to disrupting the status quo and filling the delta. For example, ambient listening reduces documentation time for clinicians during admissions from 2-3 hours to 30-45 minutes. Time savings should come from reducing the burden of documentation, not from spending less time with patients, he said.
Other tools that automate data processing also reduce the burden of documentation.
Medication reconciliation can take 30 to 45 minutes of a clinician's time, but Rutledge said the new HomeCare Homebase feature, which automatically enters a patient's medications, can cut that time to 10 to 15 minutes.
“This is a huge win for clinicians, industry and patients,” Rutledge said. “It's little things like that. You should pursue transcription and (ambient) listening, but don't overlook the really simple things that are already out there that can provide immediate value.”
This medication reconciliation feature still requires a clinician to review the technology's recommendations, but Rutledge said this is a key component to the use of AI in healthcare.
Home health care providers are increasingly leveraging AI to simplify operations, reduce clinician burden, reduce costs, and facilitate value-based care arrangements. While highlighting the potential of AI in home care, some healthcare providers warn that AI-enabled tools also come with certain risks.
“Even if you turn on something like AI ambient listening and say, ‘Okay, this is great, it cuts my time in half, now I have to see twice as many patients,’ that’s not a win either,” Mike Johnson, principal investigator for home health innovation at Bayada Home Health Care, previously told HHCN. “We still need time to check our notes and discipline to make sure we don’t trust until we trust.”
For Rutledge, ensuring AI tools are ethical and unbiased, and that humans are included in the process, can alleviate AI-related concerns. Clinicians are crucial in detecting hallucinations and protecting patients, he said.
The introduction of new technologies such as AI requires investment, but home care providers face challenges that lead to widespread cost pressures. From fierce competition for staffing to increased administrative burdens, providers are dealing with slim margins that can limit innovation budgets.
Providers can evolve their traditional operating models to overcome these challenges, Rutledge said.
Traditionally, providers have branch offices in multiple geographic regions and are staffed with highly specialized positions, such as reception coordinators, schedulers, and pre-billing representatives. To reduce sales costs, providers are likely to centralize functions and establish regional or centralized branches with fewer employees, he suggested.
Home care providers can also generate new revenue streams.
“There are gaps in care that payers really care about,” Rutledge said. “So if you're already in the home, you can already identify and address gaps in care, and payers will pay for new revenue streams. … Yes, we have the old operating model, so reducing some of the costs is a priority, but can we inject new revenue streams that payers care about?”
Ultimately, determining prayer needs should be the industry's top priority, Rutledge said.
“There's a huge opportunity there to solve both what payers are trying to solve and what the home care industry is trying to solve,” Rutledge said. “No one talks about it, but no one really knows what payers want and how they work together in the marketplace. … I think there's an opportunity to really think about what payers want and how to achieve it.”
