The beginning of a new year is an opportune time to reflect on the past year’s trends and challenges and prepare for changes to come.
In 2019, homecare continued to gain prominence as a valuable and vital part of the overall continuum of care. More and more individuals are choosing to age in place, and homecare is becoming more widely recognized for its ability to keep seniors out of the hospital and save billions of dollars in healthcare costs annually.
With 2019’s positive points came difficulties as well. To meet the growing demand for care in the home, many agencies struggled to recruit and retain qualified caregivers. This has been identified as the number one challenge for homecare agencies, and in 2019, the need for qualified aides only grew more urgent.
Additionally, the January 1, 2020 Cures Act deadline loomed over the homecare landscape, until the second half of the year when CMS announced that states could apply for a Good Faith Effort (GFE) Exemption—allowing them to delay electronic visit verification (EVV) implementation for up to one year. This resulted in all but one state applying for a GFE, and 49 official approvals, including Washington, D.C., to date.
Now, let’s take a look towards the future of homecare with HHAeXchange’s predictions for 2020.
Prediction #1: The shift to value-based care.
Continued movement by plans to value-based payment (VBP) models will drive providers to adopt technologies for cost-effective patient monitoring and a timely capture of change-of-condition information and social determinants of health. As the lines blur between clinical and non-clinical indicators of health, VBP contractors will aim to realize savings while achieving quality outcomes for clients by integrating health and human services. What have been more traditionally clinical observations (i.e., changes in weight or skin condition, irregular bowel movements, nervousness or agitation) will become a standard part of day-to-day homecare, as will environmental factors like economic stability, housing, educational inequities and lack of adequate nutrition. More fully integrated care models will evolve to address high-risk, complex health needs and to maximally align CMS payment reform for Medicare to State Medicaid budgets. All stakeholders will engage in payment delivery transformation as payers and providers are incentivized to reward the delivery of high-value care and ensure the long-term financial sustainability of the system.
Prediction #2: Greater collaboration between payers and providers.
Payers and providers will collaborate more in 2020 to achieve greater outcomes and operational efficiencies. In the past, there’s always been a natural clash between payers and providers over patient care and billing, however with the rise of value-based outcomes and adoption of new technologies, a more value-focused health care system that responds to the needs of patients and communities is on the horizon.
Member and authorization management, as well as revenue cycle billing and payment processes, will continue to improve as payers and providers adopt technologies that make them both more efficient and allow them to communicate with each other in real-time. And as EVV deadlines approach, big data and business intelligence will be utilized by payers for increased visibility and to ensure compliance across their provider networks.
Prediction #3: An increased focus on caregiver well-being.
Caregiver retention will be top of mind in the industry. A greater emphasis will be placed on caregiver satisfaction through more frequent and thoughtful surveying, and agencies will be more responsive in terms of how they deal with that feedback in order to attract, recruit, and retain long-term care workers and decrease their risk of turnover. With burnout, also known as compassion fatigue, being recognized as a serious medical condition impacting a large number of caregiving professionals, providers will be more attentive to their aides’ needs and do more to ensure their physical, mental, and emotional health.
Providers will also make caregivers’ financial well-being a priority through more consistent scheduling and by offering opportunities to take on additional shifts and advance their training and skillsets for career ladder progression.
Prediction #4: Downward pressure on State Medicaid Global Spending Caps, leading to rate cuts across the board.
Many states will continue to be challenged by massive Medicaid deficits. For example, New York State is facing a multibillion-dollar Medicaid deficit in 2020, largely due to the higher than expected enrollment in Managed Long-Term Care (MLTC). The New York State Division of the Budget estimates that the Medicaid Global Spending Cap will exceed its indexed growth by approximately $4 billion this year, thus allowing for extraordinary spending cuts to avoid the Global Cap being pierced. The first line of defense for many states is putting in place a variety of cost-containing measures for fiscal year 2020. New York recently instituted a 1% across-the-board rate cut to both providers and health plans, retroactive to January 1st. This will drive increased pressure on both health plans and providers, especially amidst the national shift toward value-based payment arrangements.
Prediction #5: Continued growth of consumer-directed programs.
Consumer-directed programs are important tools for ensuring that individuals with long-term care needs can remain in the community, particularly in rural areas where there is limited access to personal care services. The growth of these programs continues to be one of the largest drivers of cost growth in state managed care programs overall. To address the growth of consumer-directed program utilization and costs, states will seek to attain more oversight through qualified entities that can work with the state and provide intermediary billing and administrative services. Newly released CMS guidance regarding the applicability of EVV requirements to personal care beneficiaries with live-in caregivers will also give States the flexibility to apply appropriate oversight in order to curb fraud, waste, and abuse.
The population of the United States is rapidly aging and experiencing more complex health issues and comorbidities. With hospital and facility costs continually rising, there will be a harder push to provide quality care in the home in 2020.
Patients can age in place as long as homecare services account for all aspects of patient health. This year it will be paramount for the home health industry to focus on consolidating care while delivering quality care. Technology will play a key role in keeping patients at home, especially in cases where it can be used to identify subtle changes in a patient’s condition that if left untreated may cause the patient to decline and end up hospitalized.
At HHAeXchange, we view the shift towards value-based care and more widespread technology use as a positive trend in the industry, as these changes will ultimately allow seniors to more safely age in place, and improve the cost effectiveness of our overall healthcare system.