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Need For Modifying Home Health Benefits

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In order to revive the home health care industry and make the service better and timely, it is required to modify the home health benefits on an immediate basis. This will help in substantial utilization of the resources and at the same time provide enough incentives to the partners to the upstream referrals.

  • Utilization of home health benefits and its modifications is necessary to make home health and post-acute care a lower-cost setting and a more effective system.
  • In addition to that, it will also ensure that more and more patients receive their care at home which they prefer most.

It is, for this reason, there is a change noticed in the economic trend as well which is in general aimed toward a service that is:

  • More personalized
  • On-demand and
  • Provided directly to the consumers.

The market for home care Philadelphia is therefore expected to see noticeable shifts in the near future in terms of consumer demands. It will be based mainly on how these people consume home health care services.

However, the big question involves the timing of such a shift toward home health. This is because as of now, it is unclear as to when more such services will be provided in the home. Nevertheless, the home health care system seems to be moving towards a larger use of home health benefits ultimately.

Lack of Consensus

There seems to be a lack of an accord regarding modifying the home health benefits amongst the policymakers, stakeholders and key thought leaders. The difference in opinion seems to be in redefining such benefits.

  • A majority of them think that Medicare home health benefits are required to be more flexible so that these can be provided to the patients based on their specific home health care needs
  • A few others suggested that it should be more integrated with the care process and services for the specific patient as well as the primary care physician
  • Others, on the other hand, opined that it is not politically feasible to expand the Medicare home health benefits to cover more services and
  • Lastly, a few others went a step further and suggested that it is unnecessary to make any changes in the eligibility criteria for availing such care services that are covered by the benefits.

Moreover, this difference in opinions will not be limited to the definition and need of such modifications only. The experts predict that it will increasingly shift towards other areas such as:

  • Bundling of payments
  • ACOs and
  • Medicare Advantage.

This will happen especially for those entities and organizations that take on more risks while providing such services. They should have more flexibility so that they can define and optimize home health care coverage.

More Difference In Opinions

The difference of opinions does not end here. There are also a few other thought leaders who suggest that as of now it is required to remove the homebound requirements. They suggest that:

  • It is more important to focus on other important areas such as whether or not the beneficiaries should have a more definite number of chronic conditions that may lead to ADL limitations and
  • Medicare benefit should be more agile to provide better results instead of being defined by and restricted to a 60-day episode.

There are even a few others who admit that Medicare does not provide any care benefit on a long term basis. Other key stakeholders asserted the fact that Medicare benefits must be changed so that it responds to the needs of the entire Medicare population who typically lives with medical conditions for a considerable period of time and it increasingly results in a range of chronic conditions and ADL limitations.

All these differences in opinion compelled all thought leaders and a wide variety of stakeholders to sit and discuss the need for making the home health care system more responsive to the needs and preferences of the patients. Such need arises especially because it relates to a few important long term cares whose needs are typically left unmet.

Lack of a Single Model

The reason for so many differences in opinion is the lack of a single useful model that can help in managing the patients that involve:

  • Post-acute care patients
  • Patients suffering from chronic conditions
  • High-risk patients and
  • Patients having care needs for the long term.

This absence of a single model hinders in the process of identifying any evidence that in post-acute care there is a clinically defined care pathway that is most effective. This is because the care needs of the patients, as well as their socioeconomic status, are so diverse.

The ACO providers, as well as the hospitals in bundled payments, will also need to have increased attention to the evidence regarding high quality and efficient care.

  • This will somewhat make the process for determining the clinical care pathways.
  • It will also help in the PAC or Post-Acute Care utilization.

Typically, ACOs are more concerned about the absence of evidence-based protocols for different patient populaces.

Need For Managed Care Plans

There is a need for a more organized and managed care plans. This will generally report the understanding and ensure firmer post-acute care. This can be now easily managed through prior authorization and selective contracting. However, the industry is so disjointed that a single health plan will struggle to address the home health network.

Within the Medicare FFS spending structure, the post-acute care spending is found to have the widest variation and within the post-acute care spending, the home health care segment has the most variation. This means that home health care providers face constant pressure to manage bundles. This warrants them to have a closer look at their network and the home health utilization process.

Therefore, to sum up it can be said that modifying the home health benefits will certainly define rehabilitation as well as the criteria for such a rehab process. It will help the home care service providers to decide which the most appropriate situation is when such care services should be offered.


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