Wazzup Pilipinas!
If you want to solve the health care puzzle of US that is the buzzword now with the changes brought in by the CMS, you will have to consider piecing together all those things that involves non-medical home care.
You will have to focus on the social and economic determinants as well of health.
Apart from that you will need to consider the palliative care that is designed to enhance the end-of-life comfort of the members as well.
When you have placed all these pieces together at their designated place in the puzzle, you will have to glue them using communication, culture and data.
There is a continual expansion of the Medicare Advantage program which ideally all the home health care agencies are uniquely positioned to capitalize on. This will play an important role in solving the puzzle.
For this you will need to know the broader aspect of health care integration, the potential hospice MA carve-in as well as the Primary Cares First Initiative that is launched by the Centers for Medicare and Medicaid Services. In addition to that you will need to know several other topics of conversation such as:
The integration of Kindred at Home
Rise of the pay-provider model and
The shift from volume to value-based home health care.
The thing that will really intrigue you is the integration of the payer and the provider around a home and the member.
You will have to do a lot of work to understand how the payer and provider integrate and how they partner. You will also have to be adequately knowledgeable about some of the new payment models such as:
Bundled payments
ACOs and
The Comprehensive Primary Care Initiative.
All of these factors will align the provider for home health care Philadelphia with the care receiver as well as the outcomes that the providers are trying to produce.
In most of the cases the providers usually take the risk in trying to align the community-pharmacy partnership, population health and the community based efforts. This will help the provider to support the patients between and even prevent doctor visits.
Another exciting thing about the puzzle is the integration around the home that is where the patients live. This is a very personal place that will have a lot of contextual features of the lives and different aspects of the patients. In fact, it is this setting that will help the home health care provider to create a bigger impact and produce a more holistic improvement in the lives of the patients and people they serve.
Another very thing about working for a Medicare Advantage plan is that there will be a lot more flexibility regarding how the providers support and engage home health care.
All in all, such a puzzle will not only be fun to solve but will also help you to be more creative, cooperative and comprehensive while all the time you will be able to be around that rules of traditional Medicare. MA and non-medical home care
These days, typically it is more about MA and non-medical home care. As far as MA is concerned it is of course more flexible as it was always in this space. However, the magic lies in trying to reach out to people where they live because you will need to understand the impact and influence of their social, behavioral as well as physical health needs.
The CMS has afforded some of the flexibility with its MA plans along with a few supplemental benefits.
This provides a huge opportunity to the home health care service providers to be much more proactive than before regarding meeting patients where they live both literally and figuratively.
This does not only involve meeting them in their homes but also involves meeting them along with the barriers as well as the personal and mental challenges that they face.
This means they can be isolated, mentally depressed and even have problems with transportation. It could also be that they do not have healthy food to eat.
All these things form the bigger pieces of the puzzle that when fixed will give you a better picture but will place you a broader puzzle.
It is this specific area that you should focus now. This involves how you will pull all those remaining pieces together so that you can help your member in the true and best possible way.
The significant CMS moves
If you look at the historical perspective you will see that fairly recently the CMS has made some moves that suggests that hospice may be carved into Medicare Advantage. The policymakers even were encouraged to test this idea and put it into their policies. This is how the Value-Based Insurance Design or VBID was born and is expected to roll out in 2021.
However, the parameters of these are still not clear but you can expect it will be better and most effective to eventually carve in hospice into MA. As of now there is a forced choice between the two:
Curative treatment or
Palliative treatment.
According to type of treatment offered the payment too comes from different sources for that particular treatment. Well, this can result in forced choice delays care which in turn may create a great deal of anxiety for those patients suffering with advanced illness.
However, the idea behind carving hospice into MA is to provide a more seamless transition.
Therefore, theoretically and over time such an approach will stay and prove to be better in the fields of home care, home health, palliative care and hospice.
The main thing is that you do not have to go through the problems of having to change payers.
More importantly, you do not have to change the networks and all other things. In addition to that you are also not forced to make any of these decisions which may eventually make your feel that you are giving up something.
Therefore, CMS is really making an investment internally to create a better home health care system that could be ideally called the enterprise clinical operating model.
Ross is known as the Pambansang Blogger ng Pilipinas - An Information and Communication Technology (ICT) Professional by profession and a Social Media Evangelist by heart.
