This article is part of the HHCN+ membership
Achieving optimal patient outcomes in wound care is increasingly linked to a value-based approach that emphasizes quality, efficiency, collaborative, data-driven treatment.
Leaving the traditional fee (FFS) model, value-based wound care focuses on healing success and cost-saving through holistic assessment, advanced technology and shared financial incentives from providers, and ultimately changes the way wound care is delivered.
“For too long, cost and quality have been seen as a trade-off,” Dr. Chris Mason, president and CEO of Rebirth Advanced Healing, told Home Health Care News. “The reality is that the most effective cost management is to provide high quality, efficient care that makes it right for the first time.”
Rebirth Advanced Healing provides home wound care for chronic wounds using proven treatments to restore healing and independence. Headquartered in Traverse City, Michigan, the organization has 21 states.
Under value-based reimbursement arrangements, wound care providers are rewarded by successfully completing patient outcomes rather than simply taking more steps. Advocates say the model emphasizes quality and value.
Mason explained that traditional models could cause clinicians to use cheaper dressings or covers for months with stagnant wounds. It seems like an ostensibly cost reduction, but it requires additional visits and may contribute to the patient's long-term suffering. It can also lead to expensive hospitalizations due to infection.
According to Mason, Rebirth uses a “right time and right treatment” approach, which uses data to understand the patient's background and habits and develop the best treatment plan. This method can increase initial costs, but it can help you close the wound quickly, save money on nursing time, supply, and prevent complications.
“True transformation occurs when you stop managing the cost of line items and start managing the total cost needed to heal by focusing on quality and outcomes,” he said.
However, implementing value-based wound care poses challenges. One of the challenges Mason highlighted is developing financial models that benefit patients, clinicians and third-party payers.
“The traditional service fee model doesn't reward quick and efficient healing,” he said. “We believe the solution is to move towards gain sharing or shared savings models. We invest in specialized care to heal the wound faster and help home healthcare or health systems avoid the massive downstream costs of complications, readmissions and other issues.”
The value-based model allows companies to share some of the documented savings, Mason explained. He believes this approach addresses the core challenge by adjusting everyone's financial incentives to the same goal.
However, one of the biggest challenges is to harmonize the refund model with what happens on the ground, according to Chris Merritt, senior vice president of Home Health at Empath Health.
“Beyond that, it's a challenge to make sure the consistency of the documentation and the tools and training that clinicians need,” he told HHCN. “I think there will be a strong partnership between payers and providers to address these key points, and (organizations) need to be robustly educated for their field staff.
Based in Clearwater, Florida, Empath Health offers comprehensive care programs including hospice, home health, wound care, palliative care, grief services, seniors (pace), adult day services, and primary care services. It is the parent company of 18 affiliates and four charities.
Technology enhancing results
Wound care providers often use technologies such as remote monitoring and advanced diagnostics to accurately measure, track and support informed treatment decisions, ensuring that everyone involved in the care continuum follows appropriate recommendations for rapid healing.
“There are a lot of technologies on the market, and while it can be difficult to screen these processes, technology is a game changer in wound care at the end of the day,” Merritt said. “Remote monitoring provides real-time visualization of patient healing progression, but advanced imaging and diagnostic tools can detect subtle changes early. These tools help clinicians to provide timely interventions, keep patients at home and ultimately reduce the need for hospital visits.”
However, Mason warned that technology should improve, rather than substitute for essential clinical skills.
“For us, the most influential technology is what enhances our ability to communicate, collaborate and demonstrate our value,” Mason said. “The foundation is secure electronic health record systems, and other platforms that support them are invaluable for case conferencing, telehealth and telehealth.”
According to Mason, technology becomes essential in a value-based world when it involves tracking and validating outcomes that drive new financial models. He said that proposing a shared savings model requires unrefutable data to show wounds that heal faster, and that costly complications have been avoided. The right technology provides a platform to capture that data and creates “undeniable business cases” for value.
Another technique that facilitates wound care for clinicians and provides evidence of value-based care is wound photography, according to Kathleen Colcolan, associate vice president of the wound care program at Centerwell Home Health.
“Wound photography is important in wound care practices, but especially in home health, because it gives it a visual history,” Corcoran said. “This allows us to convey patient information and assessment details, in addition to photos that will help to facilitate decision-making when bringing in experts for consultation.”
According to Corcoran, digital imaging, commonly found in home health, adds another layer by taking measurements that provide objective data that providers can use to analyze wound improvement or trends within the organization and identify areas where additional education can be provided.
“Having a digital intelligence platform that can extract data from document sources and provide healing and practice trends has benefited us,” says Corcoran. “It provides a targeted approach to the way we provide and deliver care and educate our staff.”
Humana's Centerwell brand includes home health, primary care and pharmacy services. Its home health segment has over 350 locations, over 9,000 clinicians and serves more than 350,000 patients a year.
Focused on caring for all people
According to Mason, the six core fundamentals collectively impact all cellular processes in the brain and body: movement, nutrition, supplements and medication, stress, sleep and healthy positive relationships. Chronic wounds are more than just holes in the patient. According to Mason, it is a symptom of a condition that affects the entire person.
“The way to get to everyone and optimize the entire system, including all cellular processes, is through these six core fundamentals,” Mason said. “Treat the wound and ignore the patient's understanding of movement, nutrition, sleep, stress, relationships, comorbidities, mobility, and care plans. In that case, you set it up for the patient and your own failure.”
FoundTech CEO Christian Rodriguez agreed that some of the most advanced care to patients understand every aspect of their condition beyond the wound.
“When evaluating a patient, you are applying an overall clinical delivery model, an approach that improves the nursing process to ensure continuity of care over time,” Rodriguez said. “Sometimes we find gaps in care coordination that can be avoided. For home healthcare institutions, it is not only about benefiting patients, but also having the opportunity to not only achieve better outcomes, but also to assess all social determinants of their patients' health and provide the necessary resources, promoting a coordinated environment among support services such as professionals, primary care providers, social workers and nutrition support.”
Headquartered in Hollywood, Florida, Thedtech is a nationwide home-based provider specializing in wound care and chronic wound management.
In the case of merit, the overall approach leads to faster healing, reduced complications, and increased patient satisfaction scores.
“Patients are seen, heard, felt positive and involved in recovery,” he said. “Healing isn't just the wound itself, I think that's something that we have to think about as a clinician. We need to understand how health and comorbidities affect the wound, and even the patient's emotional state and support system.”
When it comes to achieving optimal results, an interdisciplinary approach is essential and adds to value-based care models.
“The success of wound care often depends on the adjusted input,” Merritt said. “Each discipline brings unique expertise and when communication flows, patients benefit from a more retaining, unified care plan. The fact that all disciplines view patients differently allows them to combine those perspectives to create a more powerful, outcome-driven care plan.”
