Trends in the Shifting Point of Care

That’s left providers scrambling to do more with fewer clinical employees. And it adds to the many challenges of trying to recruit or retain workers to do home health visits: It can be difficult — and lonely — working with a patient on your own

• It’s not uncommon for caregivers to arrive for an appointment to find the patient isn’t home
• Home health caregivers spend a lot of time driving, usually in their own vehicle, which sees plenty of wear and tear Certified nursing assistants (CNAs), for example, are paid the lowest of all nurse types and can make slightly more in hospitals and skilled nursing facilities than in home care, according to Bureau of Labor statistics.

The era of healthcare consumerism is finally here

At long last, consumerism has arrived in healthcare. After all, people have long been able to pay their bills, order food and shop for clothes online or from their phones; why should healthcare be any different? Healthcare has a lot of room for improvement when it comes to making services more convenient for consumers, who’ve become accustomed to long waits to be called back to an examination room, filling out reams of paperwork, answering redundant questions and so forth. The shifting point of care helps address consumers’ rising expectations in several ways:

• By providing options for where appointments can happen. (For example, in a clinic housed in a larger retail store, via virtual visit or telehealth, or through a home care visit)
• By offering the ability to book an appointment online, respecting patients’ availability
• By offering alternatives that may be seen as safer during the pandemic

Home healthcare, an estimated $115 billion market in the U.S. in 2022, represents perhaps the pinnacle of customer convenience, and the industry is not surprisingly growing. One analysis forecasts the industry to grow at a compound annual growth rate of 7.3% between 2018 and 2028. That’s at least in part down to simple consumer preference. Today’s retirement-age seniors prefer to age in place.

Surveys consistently find an overwhelming preference by seniors to live out their golden years at home rather than move into assisted living. Home care also dovetails well with value-based care models, since it’s a much lower-cost setting in which to provide post-acute transitional care.

In fact, CMS has announced a nationwide expansion of the Home Health Value-Based Purchasing model from the original nine states where it piloted the program, with the first performance year under the nationwide expansion occurring in 2023. CMS said the participants from 2016-2018 achieved an average 4.6% improvement in quality scores and delivered savings that averaged $141 million annually to Medicare.

The advent of value-based care models

As its name implies, the Affordable Care Act of 2010 sought to lower the costs of healthcare in the U.S. in part by incentivizing the value of care provided. It established the goal of moving away from traditional fee-for-service reimbursement toward payments that are linked to quality outcomes and lower costs. In addition to Home Health Value-Based Purchasing, CMS has established a number of value-based payment models, a few of which are listed below, with their names offering clues to how they operate:

• Medicare Shared Savings Program
• Next Generation ACO (accountable care organization)
• Hospital Readmission Reduction Program

Another model made more attractive by the pandemic are the Hospital-at-Home programs run by many hospitals, where certain patients are deemed eligible to receive acute-level care in their homes. In a recent survey, Healthcare Innovation found that roughly 70% of respondents had either fully implemented a hospital-at-home program, had gone live with an initial implementation or were in the planning stages. The CMS version is called Acute Hospital Care at Home and requires use of a waiver to admit patients to home care from the hospital.

One of the biggest changes home healthcare agencies are grappling with is CMS’ new Patient-Driven Groupings Model, which took effect in 2020. Among other changes, it eliminates the use of therapy service thresholds and removes incentives to provide unnecessary care in an effort to encourage value over volume.

PDGM shifts the focus to care based on demographics and other factors that influence patients’ outcomes, and it also cuts payment periods in half, from 60 days to 30, with each payment period classified under a variety of clinical characteristics and other information. The model also encourages home health agencies to take on more clinically complex patients — meaning they will likely need to expand their care teams through the addition of certain skills and specialists.

Ramifications for providers

What do all these new payment models mean for healthcare providers? For starters, there are new regulatory burdens and a slew of new administrative responsibilities. You’ll likely need new tools to help you monitor spending and measure quality improvement efforts and patient outcomes. In addition, healthcare providers will need to pay close attention to details such as:

• Accurate diagnoses and diagnosis codes
• Referrals — which is especially challenging, given that many referrals come via fax
• Access to the referral source and information about patient diagnoses, co-morbidities and supporting documentation from the referring provider or facility
• The ability to access and assign the right home caregiver based on their credentials, training or qualifications In short, the shifting point of care puts a premium on efficiency in provider operations.

How mobile technology can help

One of the biggest challenges for providers that take on mobile workforces is around scheduling, with risks including missed appointments, poor allocation of resources, unhappy patients and employees and lost opportunities. Left to manual processes, scheduling can make your organization less productive — in fact, in our survey, 72% of executives said worker productivity is negatively affected by their existing technology.

Automated scheduling offers the major benefits of increasing productivity and, critically, keeping not just your patients but your employees happy. That last point can’t be understated; in an industry that sees a roughly 60% annual employee turnover rate, there’s abundant research linking digital maturity and worker autonomy with employee satisfaction. Giving your mobile caregivers the tools they need to do their jobs efficiently and effectively makes them more likely to stick around.

Yet among the healthcare providers we surveyed, fewer than one in seven had a high degree of autonomy today. Three in 10 said their mobile caregivers had a low degree of control over accepting job offers in real-time or influencing their work schedules. Employers know they need to accommodate the wide variety of full-and part-time caregivers, contractors and per-diem workers that typically provide home healthcare by offering flexible schedules. But most home healthcare workers see high variability in their scheduling. Either they don’t get enough appointments, or they see inconsistent volumes of appointments from week to week, drastically affecting their income. And many spend too much time traveling between appointments instead of caring for patients.

Automating the scheduling process can resolve all of these issues

Automated scheduling uses artificial intelligence to select the right employee for the job based on skills, certifications, location, patient preferences and other factors. It can handle high volumes of incoming requests and generate a schedule that helps providers succeed in the shifting point of care, with benefits including:

• Increased efficiency
• Reduced operating costs
• Making scheduling proactive, with real-time updates to users and insight into busy times of the week or late-breaking changes
• Keeping patients happy
• Reduced employee turnover, through more predictable and consistent scheduling that empowers caregivers

Automated scheduling technology matches patient preferences (such as preferring a female or bilingual caregiver) and clinical needs to the right caregiver. Conversely, it allows caregivers to work at the top of their licensure and pay grade. Automated scheduling also helps optimize travel for caregivers, so appointments are clustered geographically to minimize travel times. Another key benefit is the ability to enter and access data in real-time for caregivers and back-office administrative workers alike:

• Logistical notes: Caregivers can leave helpful reminders about things like door or gate codes, dogs or other hazardous conditions to watch for, and even observations about the living environments of patients that may affect their health or the caregivers’ ability to provide care.
• Point of care: Which is important because reimbursement rates can be different depending on where care is delivered.
• GPS data: Location tracking helps caregivers navigate to and from appointments, helps schedulers track caregivers in the field and boosts safety for lone caregivers.
• Electronic Visit Verification: Creates a digital record to satisfy the Medicaid requirement.

What to look for in a mobile healthcare scheduling solution

Ask the following questions as you look into technologies that can improve your scheduling processes and make life easier for you, your patients and your mobile workers:

1. What are the security protocols covering the software’s connectivity? Because you’re communicating about sensitive patient data, the software must be secure and HIPAA-compliant.
2. What is your tech strategy? Advanced use of APls to connect and communicate among platforms must be a critical concern. APls are a more secure channel for transferring data such as provider insurance, payroll information, medical documents and information covered by government oversight.
3. Can the profiles you create of your mobile caregivers include specifics on their specializations and certifications?
4. Can you track your workers in real-time along the route for better communication with the patient and office administrators?
5.  How much time will this software save your scheduler in coordinating and adjusting schedules, then communicating with your mobile caregivers and other involved staff about the latest arrangements?
6. How does this solution optimize office staff time and efforts while lowering operating costs and improving the patient experience?