The countless efforts to reform healthcare in the United States have been around as long as the healthcare system itself, and they’ve all essentially shared a common goal — creating order out of chaos.
Pick your metaphor — a hydra-headed monster, a five-alarm fire, a runaway train — the U.S. healthcare system has taxed the imagination and the desire to improve the quality of care while reducing cost. The road to reform has been paved with the carcasses of good intentions. But in healthcare’s continuum of change, there are approaches emerging whose progress excites the possibilities for progress. Value-based care (VBC) and home-based post-acute care (PAC) and preventative care have the potential to unite around a common cause, solving for a demographic boom that threatens the health of healthcare.
Since it was signed into law as part of the 2010 Affordable Care Act, VBC — where provider payment is based on patient outcomes, rather than the amount of service as with a fee-for-service (FFS) approach — has buoyed hope for fixing our broken system. Healthcare plans have embraced VBC and seen promising results with primary care physicians (PCP), surgical centers of excellence, and other clinical practices. Two-thirds of Humana’s Medicare Advantage members are cared for by PCPs in VBC arrangements and 85% of Cigna’s network physicians are in VBC arrangements.
Certainly, VBC is having an impact in clinician’s offices and making inroads toward changing the prevailing FFS model. However, there is an even greater opportunity for VBC to change healthcare by moving into where a surging number of patients receive care — the home.
The historic challenge is an opportunity
The projections about the country’s aging population are proving true: 10,000 baby boomers are turning 65 and becoming Medicare-eligible every day, a population that will double in percentage by 2050. But what’s equally important is understanding where they want to receive healthcare. According to an AARP study, 90% of senior adults want — and plan to — age and heal at home rather than in long-term care or skilled-nursing facilities, receiving everything from preventive-to-PAC in their most comfortable, convenient and safe environment. Though VBC and home-based PAC were birthed independently, this accident of historical timing, which has them ascending simultaneously, provides the healthcare industry with an unprecedented opportunity to finally move healthcare reform forward.
Given the population forces of overwhelming need and preference, the imperative becomes: Can VBC work in the home? Having spent a career both with healthcare plans and building PAC in the home, it’s clear to me the answer is yes, and the opportunity to is now.
Coordination is the core: The architecture of whole-person care
The potential is rooted the similar way both models are structured. Think of a spoked wheel, with the home as the hub connecting every aspect of care needed to keep people healthy. I couldn’t have said that 20 years ago, when I left managed care for home healthcare, but so much has changed. Increasingly, technology provides the capability for remote clinical management, remote monitoring and implementation of clinical services, where the benefits of a safe environment lead to better outcomes.
The essence of VBC architecture is also that spoked wheel — the coordination of interdependent services that comprise the delivery of “whole-patient” care, with the health plan as the hub. VBC has shown when a patient’s integrated health is managed by a PCP who’s accountable for clinical outcomes, it translates into appropriate care decisions that benefit health and cost. In the same way, as the delivery of home-based care has become increasingly sophisticated, the home is the central point in the coordination of whole-patient care. The parallel architecture of VBC and advanced home-based care can be optimized for mutual gain: the coordinated dissemination of benefits (VBC), and the coordinated delivery of care (the home).
Unlike the fragmentation of FFS networks, both VBC and advanced home-based care have been designed to bring together a patient’s service providers in a single network operating under a predetermined fee structure incentivized for better clinical outcomes. The distinction between FFS and VBC is the distinction between fragmentation and coordination, between a solo journey and a team effort. In the same way, the distinction between home-based and multiplefacility-based care is what differentiates coordination from fragmentation.
Prevention in the home
Prevention is the foundation of home-based whole-patient care, as it is with VBC intervention, beginning with a clinical intake that includes the patient’s home life, behaviors, contributing issues, reaction to drugs, and myriad other personal history factors and social determinants of health.
My family’s recent personal experience with COVID-19 is an example of what can now be done in the home for better outcomes and efficiencies. One week away from getting vaccines this spring, both my husband and I tested positive for COVID with home tests. Our PCP wanted us to heal at home and coordinated a nurse’s visits to administer home infusions. It worked. We recovered in a shortened amount of time, and the alleviation of our systems, prevented the risk and cost of hospitalization.
I first began working in healthcare more than 30 years ago. It was before the VBC risk-provider model existed, and there was near total reliance on FFS. It has been a long, incremental shift to a whole-person approach that prioritizes better patient outcomes by coordinating the delivery of care. The marriage of VBC and the home, one in which both partners share the bonds of coordinated care, is on the cusp of finally delivering what the system and the people it serves have wanted for so long.
Cheri Rodgers is co-founder and chief operating officer of One Homecare Solutions, also known as onehome. On Monday, Humana Inc. disclosed it signed an agreement to acquire onehome.