Home Health Workers Find an Ally through Accountable Care
The following article first appeared in CARING, and is written by Roy Beveridge, MD, Senior Vice President and Chief Medical Officer with Humana.
August 21, 2014 08:57 AM
Here’s an all-too-common scenario in today’s health care: “Robert” is a dementia patient who’s been hospitalized after a fall. He has multiple ongoing health issues, is being fed through a tube, and feels confused. Physicians have just told Robert’s anxious family he will not improve physically or mentally. After his discharge, they’ll face the daunting prospect of figuring out how to care for him.
Every day, millions of families face this sort of dilemma: a loved one whose need for complex care exceeds a family’s ability to manage it. This is one aspect of the current crisis in American health care related to home health: we have more people in need of extended health care services than we have beds in our nursing care facilities or trained home health care workers to care for them in their homes. There’s no one solution to this issue, but there are those of us working on a way to address it as well as one of the other confounding aspects of contemporary health care — the lack of coordination among the various entities involved in caring for patients like Robert.
My team and I are working to advance a program known as Accountable Care. The idea behind it is to create a role within the health care system for someone whose job is to serve as an advocate for patients and to help them and their families navigate the sometimes confusing and disjointed collection of administrative byways, alleys and cul-de-sacs within the health care system.
As someone who’s spent 30 years in health care, I think the need for someone to fill this role is self-evident on the basis of demographics alone. The 77-million-strong baby boom generation is larger than any in American history, and its members are living longer. That’s good news for many of us born between 1946 and 1964, but it presents challenges for a health care system that has never had to accommodate that many older adults. Add the growing number of Americans in this age bracket who are dealing with chronic conditions like diabetes, hypertension and heart disease and it looks like a perfect storm for a health care industry already in flux from changes in the law, technology, and economics, among other factors.
In-home health care providers are crucial to creating successful change because they are on the front lines of the fight to make health care more accountable and effective. The system we’re phasing out of today is one in which patients are largely and, in some cases, tragically on their own, facing struggles both internal and external, the former with their own health, the latter with the system to which they turn for healing. For example, in the course of having a particular condition diagnosed and treated, how many times might a patient have to answer the same set of basic health questions? If they go from their primary care physician (PCP) to a specialist to surgery, maybe half a dozen times. How many phone calls will the patient have to make? Roughly that many and maybe even more. And how many of their various providers will be talking to each other during that process? Quite possibly zero.
Afterward, the patient comes home with a regimen of pharmaceuticals that may or may not have been prescribed with an eye to how they will interact with the patient’s ongoing medications. What about scheduling follow-ups? Making sure the patient understands when and how to take medication?
Research indicates that most home health care is provided by family members, many of whom are emotionally overwhelmed by their circumstances. In addition, even when families contract with licensed home care agencies, the certified caregivers who enter the home often lack the training to manage the complex care needs of their patients. Regardless, the truth is that whoever the caregiver may be, he or she will face difficult questions about how to manage the patient’s health and may have no one to call for help.
That’s where Accountable Care enters the picture, specifically in the form of the care manager. The job of the care manager is to understand the patient’s health needs, goals, and circumstances and then help them achieve their best health, ideally at home if that’s their preference. The care manager connects the patient, PCP, specialist, hospital, pharmacist, and home health care provider to ensure the patient gets efficient and appropriate care.
In Robert’s case, for example, his care manager reached out and (though the hospital claimed it couldn’t be done) found a rehabilitation facility that was willing to work with the senior. The care manager also had Robert’s dementia evaluated by a psychiatrist who changed his medication regimen. Soon, Robert started responding and communicating his wants and needs with his family and caregivers and after his rehabilitation was discharged safely to his home.
In some cases, the care manager actually visits the patient’s home; in others, the care manager is available via phone and email. Being there for patients has made a difference, as shown by another example:
“Denise” struggled to pay her bills and the stress was impacting her ongoing health conditions. Her care manager asked Denise’s PCP to transfer Denise’s prescriptions to our company’s mail-order pharmacy, which reduced her co-pays to zero. The care manager accessed a directory of community resources to find a program that helped Denise with transportation and utility expenses. Mobility issues made it hard for Denise to easily leave her home so the care manager contacted a local resource that provided and installed a ramp for a minimal fee that Denise could afford.
In cases like these, the collaborative Accountable Care approach has made a huge difference. It’s worth noting, perhaps, that the idea isn’t new. In fact, it’s the kind of work I saw exceptional home health professionals do in the 22 years I spent as a practicing oncologist.
What’s different today is that we’re trying to make the integrated system work with caregivers to reward their dedication, and give them an ally in their efforts on behalf of patients. As we see it, to address the growing need for better in-home care, the care manager’s presence must shift from being the exception in health care to being the standard.