Desperately Seeking Value

Author’s Note: Want an uncomfortable reminder that we’re all getting older? The movie “Desperately Seeking Susan” was released THIRTY years ago! But I digress…

In the thirty years since “Desperately Seeking Susan” hit theaters, much has changed in health policy. From FDA reforms to prescription drug coverage to the Affordable Care Act and even the rise and fall of SGR, the last three decades have experienced no shortage of drama.

The Medicare program hasn’t been spared, to be sure, but perhaps its most significant changes are just beginning. Administration officials, lawmakers, health policy experts, providers and other health stakeholders are all deeply engaged in a dialogue about how to reform the Medicare program to deliver more value by improving quality and reducing costs.

As is evidenced on multiple fronts, there is real seriousness on the part of all participants. HHS Secretary Sylvia Burwell has outlined ambitious goals for tying payments to value, and CMS has launched and proposed a variety of initiatives to meet them. At the same time, Congress has undertaken considerable work on the value front, including rehospitalization reforms, the IMPACT Act, and value-based purchasing initiatives.

These efforts will only pick up further steam in the weeks, months and years ahead, no matter who wins the race for the White House next year. As they do, it will be important not solely to pursue new changes but to also give close consideration to elements of the Medicare program that have long, if quietly, generated measurable value for beneficiaries and taxpayers alike.

The Medicare home health benefit is a great example. Created in 1965 so that elderly and disabled Americans could receive skilled medical and rehabilitative care at home, this benefit has reduced the need for costly hospital visits or facility-based care for millions of beneficiaries.

Today, nearly 3.5 million homebound Medicare beneficiaries receive skilled home healthcare to treat illnesses related to acute, chronic or rehabilitative needs. Every day, skilled healthcare professionals are safely and effectively providing in the home clinically advanced care that was once offered only in a hospital or a clinical setting. Just as important, extensive research has documented that skilled home healthcare is able to effectively manage many chronic conditions at lower cost than other settings.

Home healthcare is also an area where policymakers can look to other programs as a guide for Medicare. For example, the Department of Veterans Affairs has utilized its Home Based Primary Care (HBPC) Program since 1972 to meet veterans’ healthcare needs while reducing health spending by an astonishing 24 percent. Supported by a multi-disciplinary team of skilled clinicians, HBPC participants have also experienced a 62 percent decline in inpatient hospital days and an 88 percent decline in nursing home days.

Little wonder that the VA describes its HBPC program as “a model to emulate for the care of persons with complex, chronic disabling conditions, improving quality without added cost, and maximizing their independence.”

Skilled home healthcare also helps patients effectively manage their chronic conditions, which is critical for a growing number of U.S. seniors living with multiple co-morbidities that lead to higher costs and declines in health. In recent months, we’ve seen lawmakers elevate the national discussion on how to strengthen the management of chronic diseases. Here, too, home healthcare’s experience can offer valuable insights, since an extraordinary 74.7 percent of all Medicare home health patients have four or more chronic conditions – compared to 48.5 percent of all other Medicare patients.

Last, it is broadly acknowledged that home healthcare is patient preferred. New national data released by seniors polling resource Bring The Vote Home last month show that 94 percent of American seniors say they want to remain in their home as they age, where they can be close to family and their community.

As lawmakers and regulators advance policy reforms to increase the efficiency and quality of the Medicare program, the clinical, fiscal, and human value that home health is already delivering to Medicare’s most vulnerable patient population and taxpayers can serve as a very useful model. With models such as this, perhaps the search for value won’t be so “desperate,” after all!

Eric Berger is CEO of the Partnership for Quality Home Healthcare.

Morning Consult