Earlier this year, the Centers for Medicare and Medicaid Services (CMS) rolled out a pilot program called the Home Health Value-Based Purchasing (HHVBP) program. According to Advanced TeleHealth Solutions’ Essential Guide to the Home Health Value-Based Purchasing Program (2016), the program is modeled after the Hospital Value-Based Purchasing (VBP) programs that came about as part of the Affordable Care Act. Similarly, the HHVBP program seeks to provide, measure and reimburse facilities based on the quality of care as opposed to the number of services billed for under the old system.
The Role of TeleHealth in the Home Health Program and Beyond
One of the major goals of CMS in launching the HHVBP program is the reduction of hospitalizations. All too often, patients end up in the hospital for conditions that might well have been handled on an outpatient or routine basis, had they been caught early enough.
Beyond the current HHVBP program, the implications for the telehealth services in the home health care system are staggering. The potential impact of the aging population and the need to provide more services at home are two reasons why telehomecare is likely to become one of the fastest-growing market segments. According to Dr. Maheu, the ability of practitioners to interface directly with clients and caregivers in the home, reliably and frequently, will affect all areas of healthcare. The general assumption is that people desire to make positive decisions regarding their health and the health of family members. Most of these decisions occur where they live– at home.
Equipping care managers with remote monitoring capabilities is one of the ways that Home Health companies can proactively identify and address health issues in an expedited fashion — before they require emergency treatment and/or hospitalization. More preventative and early intervention care should yield reduced hospitalization costs; and more importantly, better and more responsive care for patients.
Telehealth Interventions for Chronic Illness
Telehealth interventions can provide a valuable increase in the quality of care for patients at greater risk for medical complications, such as patients living with multiple or chronic conditions, congestive heart failure, diabetes, and more. The following health care activities are considered as particularly impactful for patient care1:
- Evaluation of medication compliance
- Symptom management, as well as side effect management for new prescriptions
- Ongoing patient education with respect to a condition or comorbidity
- Ongoing patient wellness education and support
- Monitoring and assessing a patient’s treatment plan
- Assisting patients in best utilizing face-to-face visits with home-health staff
Early evaluations of telehealth programs used in the delivery of home-health care conducted by Advanced Telehealth Solutions showed significant reductions in hospitalizations for patients with chronic conditions such as congestive heart failure, diabetes and hypertension 2.
Patient Response to Telehealth/Telehome Care
An intervention or service is only valuable if people are willing to use it. Fortunately, telehomecare has been found to be highly acceptable to clients. People who have chronic illnesses, are experiencing depression, need hospice services or counseling, or suffer from agoraphobia and need social services can be accommodated at home.
Early studies as far back as 2000 (Johnston, Wheeler, Deuser & Sousa) showed that telehomecare offered cost savings and improvement in the quality of life for patients.3 The question back then was how long it would take to create a reimbursement model that both fairly compensated providers, and maintained the cost-saving measures desired by managed care.
In this way, the pilot HHVPB can be considered a significant step in solidifying the role of telehealth in the home health care delivery system. To date, nine states (MA, MD, NC, FL, WA, AZ, IA, NE, and TN) participate in the pilot HHVBP program overseen by CMS. This pilot program will run for seven years (through December 31, 2022).
 Johnston, Wheeler, Deuser & Sousa, 2000