Presentation - The Future of Home Health

© 2013 Axxess. Unauthorized use is prohibited.

C. Sam Smith

Vice President

Business Development

‘A unique opportunity for home health agencies to learn how to position their agencies for ongoing success, by staying informed and current in an evolving,

dynamic industry.’

Presented by:

THE FUTURE OF HOME HEALTH: AXXESS TECHNOLOGY SOLUTIONS, INC. |

2014. ALL RIGHTS RESERVED.

Merrily Orsini

Senior Business

Development

Executive


THE DYNAMICS IMPACTING THE FUTURE

I. Demand for Services

A. The Impact of Demographics on Aging

B. The Impact of Chronic Disease on the future

II. Exhibits 1&2: The Care Continuum

III. The Regulatory Environment

A. Innovative Payment Systems Dynamics

B. Fraud Eradication

C. The ACA’s affect

IV. The Technology Dynamic

V. Infrastructure

VI. The Healthcare Workforce

VII. Research and Measurement

VIII. The Outlook from Our Perspective

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II. THE DEMAND WILL GROW AND GROW AND GROW

• By 2029(the next 15 years), there will be 71 million baby

boomers over age 65, an increase of 73% from today’s

numbers.(US Census Bureau)

• More and more physicians and hospitals are awakening to the

fact --that not only do patients want their healthcare in the

home, but Home Care is significantly less costly than hospital

or SNF care.

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• Requirements for more service exceeding supply of care

providers

• Pay for service models emerging in ACOs, local non-profits,

proprietary businesses, physician practices

• Greatest transfer of wealth in the world’s history

• Naturally occurring retirement communities, and

congregant neighborhood aging communities

• Care recipients that are older, healthier, more demanding,

and with financial resources

II(A). THE IMPACT OF DEMOGRAPHICS OF AGING

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II(B). THE IMPACT OF CHRONIC DISEASE

Milken Institute:

Every one of the 7

major chronic

disease

populations is

projected to grow

at a rate that

significantly

exceeds that of

the total

population.

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II(C) -WHAT CAN BE DONE ABOUT CHRONIC DISEASE*?

• Reduce the number of obese persons

• Continue the reductions in the public’s smoking

• Decline in Alcohol consumption

• Physical activity to increase

• High cholesterol will be reduced to pre 2000 levels

• An improvement in overall air quality

• A gradual decline in illicit drug use

• A modest improvement in early intervention and treatment

• Lower health care cost growth

*According to the Milken Institute

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II(B). CHRONIC DISEASE: HOW CAN IT BE MANAGED MORE EFFECTIVELY?

Milken

Institute:

Should the

initiatives of the

USA be

implemented

and carried

through,

significant

expenditures

could be avoided

by 2023.

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II.(B) - A MORE HOLISTIC LOOK AT THE CARE CONTINUUM

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II.(A) - THE CARE CONTINUUM

Primary Care Support

Post Acute Care

coordination

Advanced Illness Care Expansion

Well/HealthyAT RISK Chronic Care

ManagementComplex Care Management

Advanced Illness

Palliative

Care

Hospice

Care

Coordination

across

providers

Preventing re-

hospitalization

Care

Coordination

across

providers

Mitigation of RiskPromotion of healthy lifestyle choices

WellnessPrevention

Continuum

diagram-

Courtesy of

VNAA

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III. THE REGULATORY ENVIRONMENT

All future regulations are aimed at accomplishing the Triple Aim:

• Improving the patient experience of care (including quality and

satisfaction)

• Improving the health of populations

• Reducing the per capita cost of healthcare

• Quality of Outcome: We will see an increase in the Systems and Methods

to enhance quality of outcomes. These include Care Pathways, care

monitoring techniques and reporting.

• Cost Containment Methodologies will grow—Bundled Payment Care

Initiatives [BPCI] - More BPCI’s will be active, moving patients along the

LTPAC continuum- (HH is the preferred provider and the low cost provider

and will receive most patient care tasks in the home)

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III(CONT.) REGULATORY ENVIRONMENT: ICD-10 IS NOT GOING AWAY

• ICD-9 to ICD-10 conversion is forthcoming, in spite of the delay to

October 2015.

• We must be about training and preparation for this fundamental

change.

• With ICD-10, Healthcare workers will begin dealing with approximately

70,000 diagnostic codes rather than just under 7,000. The implications

for HHRG’s and reimbursement are significant.

• Axxess is preparing and will be ready for the code set change prior to

10-1-2015

• Axxess will be conducting training for all its clients for 2014 and

201511


THE TRIPLE AIM OF HEALTHCARE REGULATION

Improve the health of

the population

Better care experience:

Improve the experience

of the patient

The Triple Aim

Reduce Cost:

Improve the affordability of healthcare

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III. THE REGULATORY ENVIRONMENT(CONTINUED)

• Erosion of the Medicare 60 day episode, to outcomes based

discharges and cost containment, as well as other models created

because of changes in industry

• Medicare/Medicaid will continue to drive private insurance

changes, standard procedures.

• HIPAA compliance audits and enforcement actions are likely to

continue to increase as data security issues continue to proliferate.

• Regulators and Insurers, and BPCI Convenors will rapidly

recognize the value of home health due to its cost drivers

versus hospital and SNF costs. However, because of the

payment per episode, a less expensive alternative is being

sought as well.

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III(A). INNOVATIVE PAYMENT SYSTEMS DYNAMICS

• The system is fragmented, in silos, and non collaborative, but it is moving to

cohesive collaboration, centered around Population Health Management

• Payment Systems being organized in regional markets

• A slow evolution. Payment has been driven by specialty along the continuum, it

will become more and more outcome and value driven

• Revenue earned by the HHA will be because of its positive patient outcomes

• Regional Systems are slowly moving towards Meaningful Use, meaning

interconnectedness of the technologies of hospitals, physician clinics, SNF's, and

HHA data.

• Bundling of services under a central “Convener”, such as a hospital, an ACO, a

healthcare system is slowly progressing.

• Bundling will yield payments being made to the BPCI, then carved out and paid to

the various participating providers, per Service Agreement

• Home Health will emerge as the patient favorite, as well as the bargain of all

stops on the continuum

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III.BPCI POPULATION HEALTH MANAGEMENT RISK / CHRONIC DISEASE

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Actuaries will weigh the

Population Segments,

according to Risk of

Hospitalization, according

to probable outcomes of

the patient population.

Insurers “weigh” the

relative risk of each strata

of risk.

Key determinants: Cost of

Care, Patient Satisfaction.

In all aspects of bundled

payment, between

Physician Clinic, Hospital,

Skilled Nursing, Home

Health, Personal

Assistance-Home Care,

which of these services

would be less costly to the

payer?


III(B). FRAUD ERADICATION WILL CONTINUE

✓ The Feds ability to mine data and detect the fraudulent activity will get

more and more adept.

✓ The HEAT* is on, and will remain on until the levels of fraud are on the

decline.

✓ ZPIC’s and RAC’s will do their work- “Boots on the ground”

✓ Moratoria in place in FL, IL, TX, MI…this will continue

✓ Fraud is the “vermin” of Home Health, honest, hard working agencies

want this to be under control, but without unnecessary regulatory

burdens

*Health Care Fraud Prevention and Enforcement Action Team (HEAT)

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III(C). THE ACA WILL ROLL ON AND ON

• F2F, other possible changes that may take place

• Medicaid expansion will be promoted more heavily

• The ACA calls for more and more transparency for healthcare costs.

Hopefully, this will work towards home care’s benefit over time.

• Electronic technology in healthcare will continue to be promoted.

• Paper filing may indeed be formally discouraged and potentially

eliminated.

• As Insurers are more involved, more insurance providers will start seeing

the benefits of home healthcare.

• Costs will be reduced with increasing innovation, and more use of

technology within the system as well as ancillary to the system.

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Readmission rates


What Technologies will have the most impact in the delivery of care?

What are some other emergent technological advances?

IV. WHICH WILL TECHNOLOGIES WILL EMERGE FOR HOME HEALTH?

Apple, Samsung, LG and others are

coming into healthcare

RPM- Bluetooth Connectivity

Mobile apps for EVV, Care Plans, HIPAA Compliant

Messaging

Tele-Health: Video

conferencing between patient

and care giver

Care Coordination Data Transfer: HL7 & in the

Cloud

Medication management integration

Google Glass: Wearable

Technologies: Head bands,

clothing, monitors installed

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IV. THE TECHNOLOGY DYNAMIC

Emerging technologies that are impacting or will impact care delivery in

the home/community

•

• Apple, Samsung, and LG are all offering healthcare based technologies from the mobile perspective.

Apple announced a collaboration with Epic and Mayo Clinic.

• Google Glass: Vision based diagnostics; Wearable Tech: Fierce IT predicts $6B market by 2016

• Bluetooth connectivity: RPM- Remote Patient Monitoring coupled with simply mobile tablet and smart

phone technology

• GPS enabled Mobile applications for Visit Verification, Mapping, Scheduling; tied to central database;

Including Care Plans; HIPAA Compliant Messaging

• Medication Management data access for EMR- reconcile prescriptions to what is in the home

• Telehealth: The use of video conferencing for Face-to-Face Doctor-Patient Conversations, Nurse-

Patient Conversations

• Physician/hospital/LTPAC communication: Cloud based coordination has potential, enabling Private

Personal Health Information[PHI] transfers upon discharge from hospital and admission to HH,

bypassing the HIE process

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V. INFRASTRUCTURE

• Uncertain future: A Nationwide framework for data exchange is

years from being in place

• Each city, each regional market is unique, and generally

fragmented or monopolized

• Interconnected vendor systems; Epic and everyone else in Primary

Care- Is there interconnectivity? Will there be?

• Collaboration? No, instead its Competition

• RHIO/HIE : Is the answer in the cloud?

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VI. THE WORKFORCE FOR HEALTHCARE

• The AHHQI Future of Home Health project will seek to assess

and measure the workforce necessary to provide service for

the 73% increase in general demand for healthcare due to the

demographic shift.

• Big adjustments are needed in society in order to

accommodate this generational change

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VII. RESEARCH AND MEASUREMENT

The Institute of Medicine’s “Future of Home Health” project

workshop, led by the Alliance for Home Health Quality and

Innovation, is sponsored by Axxess, and C.H.A.P.( Sept. 30-

Oct.1)

The project will be looking into the issues facing home health’s

future in the health care continuum.

The findings of this project will be shared with the government

and private sector with conclusions for change initiatives.

Plus Axxess will share the results with its clients!

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VIII. THE OUTLOOK

The Secrets to Success for home health agencies will

reside in the following traits:

Flexibility

Adaptability

Continuous Learning

All systems, from internal to external, will need a focus on

interoperability and inclusion:

Across types of service

All players in the health care continuum

Technology

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VIII. THE OUTLOOK #2

✓ Home Health Agencies that are adaptive and can utilize their HH

technology effectively will be able to survive and thrive

✓ The "smart" and "agile" agencies are the fittest and are in the best shape to

effect survival mode

✓ Ability to utilize the EMR data and apply it to aid the hospital bundling

initiatives in lowering cost of patient care overall

✓ Axxess provides the industry's most adaptable, scalable and

comprehensive platform for weathering the future changes that are sure to

occur in the Home Health Industry.

✓ “ Axxess = Everywhere!” 24


RESOURCES AND LINKS

Alliance For Home Health Quality and

Innovation http://ahhqi.org/home-health/future-project

Read more: 5 ways Google Glass will innovate

healthcare - FierceHealthIThttp://www.fiercehealthit.com/story/5-ways-google-glass-will-innovate-

healthcare/2014-04-11#ixzz326jVTsKl

The Future of Home Health/ ARTICLES for further

reading…in this folder

https://www.dropbox.com/sh/le062ptfuincedj/AAAwnc1Pj

SpDko-krWE8T_bua

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http://www.fiercehealthit.com/story/5-ways-google-glass-will-innovate-healthcare/2014-04-11#ixzz326jVTsKl

https://www.dropbox.com/sh/le062ptfuincedj/AAAwnc1PjSpDko-krWE8T_bua

http://ahhqi.org

http://ahhqi.org


THANK YOU FOR YOUR ATTENTION AND

PARTICIPATION

If you have any questions, we would love to

try and answer them!

Following this presentation, our Axxess

representatives will be going over features and

enhancements of our software if you would like to

see them. Otherwise, have a great day.

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THE FUTURE OF HOME HEALTH

Health & Medicine

Presentation - The Future of Home Health