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National Association for Home Care & Hospice
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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Heath care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging


Population Health Management: Best Practices for Treating Aging Patients

By Joseph Berardo, Jr.


The prevalence of multiple chronic conditions and functional impairment within the aging population is on the rise. There’s more need than ever for a level of coordination that improves outcomes and lowers the total cost of care. Successful health care and long-term service delivery models must involve a team of providers to meet individual needs, increase access to health care, improve outcomes, and synchronize the various services and supports. 

Ideally, population health management (PHM) — the aggregation of patient data across multiple health information technology resources — includes a care coordinator who works closely with patients, as well as their family caregivers, primary care providers, and other health care professionals. The care coordinator’s goal is to foster communication, improve individual well-being and enhance outcomes.

PHM is one of the most promising avenues for thriving in the environment of health care reform. It entails identifying high-risk patients and determining which ones require individualized attention. This means developing thoughtful, patient-centric health care strategies that rely upon predictive modeling and individualized outreach programs.

Predictive Modeling

The health care industry has begun to adopt predictive analytics as a prerequisite for PHM and an important component of any approach to reducing the total cost of care. Predictive analytics put data analysis into a single, actionable patient record, enabling the care team to take actions that lead to better clinical and financial outcomes. These statistical tools are also being used to forecast which patients are likely to be at increased risk for health problems and cost more health care dollars. Some health care organizations also apply predictive analytics to large clinical and administrative data sets in an effort to identify higher-risk patients and intervene before they become seriously ill.

To be effective, however, stakeholders must develop the infrastructure and culture required to turn the data into action. They must have the ability to generate timely reports and use automation tools to apply intervention strategies across a patient population. Predictive modeling shines a light on the top percentage of covered lives that are at highest risk for illness and increased costs. These are the patients who will most likely benefit from PHM programs designed to improve their health and lower costs overall.

This level of state-of-the-art health analysis technology enables users to confidentially assess the health risks of every patient. When risks are identified and need attention, these programs can coordinate personalized guidance for the individuals who need it the most. Having the ability to provide a suite of industry-leading health advocacy services can greatly improve patients’ health and keep health care costs contained.

Individualized Outreach Programs

The goal of an individualized outreach program is to develop a healthier population over time. Such a program should be designed to evaluate the overall health of a plan population and identify participants who have common and costly chronic health conditions or who are at risk of developing them.

It’s important for health care organizations to find ways to target participants they can invite and encourage to enroll in a program that helps them improve their health. The program should have the capacity to analyze collected health data — such as emergency room visits, hospital admissions, and pharmacy claims — to identify plan participants who have or may develop chronic health conditions such as diabetes. Patients are then stratified according to predetermined metrics.

Upon enrolling in the program, participants should have access to a registered nurse after completing a comprehensive health assessment. From there, customized care plans can be developed to achieve individual health care goals and optimize participants’ involvement in managing their chronic conditions. In addition, nurses should manage the identified risk population through telephonic and on-site outreach. By doing so, nurses can give patients education, support, and access to tools they need to better handle their health.

It’s important for participants to have a trusted contact they can reach out to with questions, concerns, and choices regarding their health. Nurses can fulfill this role for high-risk patients and work with providers to:

  • improve quality of care
  • improve patient contact
  • increase compliance with treatment
  • improve knowledge and professionalism
  • improve patient quality of life
  • assist with provision of skills for self-care
  • provide and reinforce patient education
  • improve patient satisfaction

Transparent Data

In PHM, the objective is to minimize costly, yet often unnecessary or redundant, interventions. To be effective, health care organizations must focus on high-risk patients who generate the majority of health costs. They must also pay attention to the preventive and chronic care needs of every patient, all of which makes access to transparent health data crucial.

In addition, tracking health care data can serve as the foundation for quality improvements and changes in clinical behaviors. A study by The Wisconsin Collaborative for Healthcare Quality found that tracking the quality of care encourages physicians to change the way they practice medicine, increasing the likelihood of them following guidelines more strictly.

For providers, transparent health data provides:

  • Standard metrics for assessing quality of care
  • Outcome- or performance-based payment
  • Reduced paperwork
  • Knowledge of prices paid to hospitals, labs, and specialists to inform patients

Transparent health care data is vital for curbing costs and changing patients’ behavior patterns. In fact, data analysis serves as the backbone of wellness and PHM strategies, and leads to greater efficiency and effectiveness.

Automatically aggregating and consolidating data from a variety of disparate systems and sources, including inpatient, ambulatory, and home sites, has been shown to improve the continuity and efficiency of patient care. Toward that end, a number of provider organizations are striving to connect data silos and enhance transparency.

Reducing costly future medical care leads organizations’ health care costs to go down while patient health improves, making this approach a win-win for stakeholders.

Barriers to Effective Use of Transparent Data

In the past few years, there has been an explosion in public and private reporting of health care costs and quality data. So far, the results have been what many believe to be an inconsistent and at times a distorted set of quality-reporting measures. A lack of coordination and consistency of data can also undermine the opportunity to lower health spending based on potential for quality and price.

The problem is further exacerbated by the fact that so few organizations have the experience to perform meaningful analysis on the data that would allow it to be translated in a way that will foster positive behavior change. The key to taking advantage of the data is to find a way to take the burden of data collection off of providers and simplify the information.



As elder and chronic care shifts toward value-based payment models that compensate physicians based on patient care and outcomes rather than frequency of services, quality becomes paramount. Under traditional fee-for-service payment models, there was no real incentive for providers to reduce unnecessary care.

A PHM plan that is patient-centric, involves predictive modeling, and includes individualized outreach programs — all built upon a foundation of transparent data — will become the standard.

Predictive modeling allows users to assemble all of their patients’ health data, including past claims and medical records, and process it through a comprehensive health analysis system. The system identifies patients who are at highest risk for serious health issues, so providers can make a suite of proactive health advocacy services available immediately.

Furthermore, data that measures health care prices and quality can serve to demonstrate value, treatment outcomes, and level of access. In particular, a well-coordinated PHM program for aging patient populations depends upon such information to lower the total cost of care. Strategies designed to optimize this opportunity have potential to help close the gap between the high rate of U.S. health care spending and current levels of quality and access.




About the Author: Joseph Berardo Jr. is CEO of MagnaCare, an administrator of self-insured health plans for employers in New York and New Jersey.






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