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HOME HEALTHCARE 11 www.ihdelivery.com July 2014 Integrated Healthcare Delivery T he metrics of healthcare reform are well documented: episodic approach, integrating healthcare professionals for improved care transitions, cost management, value-based reimbursement, insurance reform, an emphasis on population health and a new focus on wellness-based healthcare vs. deficit-based care. Put it all together, and it points to an unprecedented opportu- nity for home healthcare, says Arnie Cisneros, PT, longtime physical therapist and president of Home Health Strategic Management, a Lansing, MI-based consulting company. "You are the desired care provider here," Cisneros recently told a roomful of home healthcare provid- ers at the Homecare Association of Washington's 2014 annual conference. However, that opportunity can only be realized if home health providers adjust their delivery of care in specific ways. His first recommendation is to get to know your accountable care organization (ACO). "There are 500 ACOs in America now. There are going to be 1,000," he says. "You can destroy Obamacare tomorrow, and the ACOs will still be coming." He notes that the ACO concept and bundled payments have been in the works for years but only became reality through passage of healthcare reform. Currently ACOs are looking for solu- tions with regards to managing care transitions. "You have to let hospitals know you're already here in this space, or they will create a program without you," Cisneros says. "Let them know you're there and willing to partner." Cisneros defines care transition as the movement patients make between healthcare settings as their condition and care needs change during the course of a chronic or acute illness. Each shift from care providers and settings is defined as a care transi- tion. The key to this concept is that the focus is on the patient, not the provider. Under the current model, healthcare providers must see more patients in order to increase revenues. The new system pays more if the patient improves faster. While this is an improvement for both the patient and the provider, the new model also involves a reimbursement strategy called bundled payment for all of the patient's providers based on 30-day episodic care, instead of the current fee-for-service method. It includes coverage for post-acute care services such as home health. This is where home health can prove its value, says Cisneros: The faster hospitals can discharge a patient to home health, the more significant the savings. Although if the patient is readmitted within the first 30 days post discharge, the entire provider group, including home health, is penalized. That also means costs are more trans- parent. "When home health runs up a bill in the bundle, everyone knows about it," he says. "They will replace you for a more cost-effective substitute." Beyond that, there is an incentive for home health to become more efficient: gain sharing. If the patient outcome is successful, home health will share in the profits. Barring Congressional changes, every hospital visit will be bundled beginning January 1, 2018. "Maybe politics will take over and it won't be until 2019 or 2020, but it's coming," Cisneros says. Opportunity can only be realized if home health providers adjust their delivery of care in specific ways. IHD_10-13_NewWorld0714.indd 11 6/13/14 11:22 AM