Supported by executives from Kaiser, LHC Group, and Liberty Healthcare, and a physician from Nashville's largest integrated health network, Robert Simione declared that "change" is the key word with which we will be living for the foreseeable future and that "adapting to change" is the strategy and philosophy that will be adopted by healthcare providers committed to surviving.
Now that it is certain healthcare reform is here to stay and that the Affordable Care Act is likely to remain the form it will take, every healthcare provider — especially providers of healthcare at home — who decides to continue to operate in ways that have brought success in the past will likely be closed or acquired within five years, very likely much sooner.
From Keith Myers, Chairman and CEO of LHC Group: "When deciding how to handle every new patient, you cannot ask anymore 'what does this patient qualify for?' You must ask 'what does this patient need?'" Soon you will be paid for the quality of your care, not for the amount of services you provide. You might as well start adapting to that change now.
From Lynn Simon, President, Clinical Services & Chief Quality Officer, Community Health Systems, Nashville: "The way to prepare to be paid for quality is to emphasize collaborations and communication."
From Barbara Knott, Regional Executive Director, Kaiser Permanente, Los Angeles: "When you determine a new patient is not homebound, don't walk away. Think out of the box to find a way to provide care. People want, no, demand personalized experiences in care, just as you demand from a hotel or airline. At Kaiser, we will do one-time visits if that is what the patient needs."
From Paul Babinski, President, Liberty Healthcare & Rehabilitation Services, Charlotte, North Carolina: "Throughout healthcare, a clarity is coming through. More than ever, we are not engaging in a conversations about quality, we are measuring quality. Every sector needs to see every other sector as partners, not competitors."
Kaiser, though it operates a healthcare at home department, actively seeks outside contractors to fulfill its range of obligations to in-home patients. CHS in Nashville looks for post-acute partners when they have a specific problem to solve, but they only consider partners capable of exchanging patient information electronically. LHC's Myers believes success in partnering with hospitals and physicians grows directly out of the in-home provider's reputation in the community.
Discourage physician competition
Kaiser's Barbara Knott has seen physician groups forming in-home care services and has been teaching Kaiser's healthcare at home department how to stop it. "Across healthcare, there are already multiple payment models," she began her advice. "All of them involve physician integration with care in the home. What you have to do is tell your local physicians that you can do healthcare in the home better than any new program they and hospitals can create from scratch. Partnering means helping them solve a problem and showing them how you are the best to solve it. So you have to do your research and know what their problems are before you talk to them."
Encourage MCO collaboration
With five experienced executives on the stage, perhaps the best advice of the morning came from the audience. Joe Ramon, CEO of Health Care Unlimited in McAllen, Texas -- where he is surrounded by criminals posing as healthcare providers for the sole purpose of enriching themselves at the expense of the taxpayer -- described how he built a collaborative partnership with managed care organizations. "I went to Anthem and the Blues and every insurance company licensed in my area. I didn't talk to the authorization clerk though; I went to the C-suite. I told them to give me their most at-risk patients, to let me try to keep them out of the hospital and save them some money."
Here is where Joe went from surviving to thriving. "Then I told them, 'But you have to take the shackles off. If I'm going to keep them health at home, you can't be telling me how many visits I am limited to and you can't be paying me less than my costs.' And they backed down! They agreed to let my nurses be nurses. Today, I'm making more money than ever and I'm saving them millions in hospital costs."
What it comes down to, and Bob Simione and his panel of executives agreed, is that post-acute providers have to be willing to take on risk. Keith Myers, for example, explained that when you accept that what you are doing is managing care in a capitated environment, you have to ramp up care for the sickest patients and control utilization for the rest. This implies you are able to risk-stratify your patient population.
Liberty's Babinski provided a useful summary of the 90-minute discussion. "You cannot talk about collaboration without talking about communication, and it goes in two directions. At conferences like this one, you go home with your head full of big ideas. Your job is to bring these big ideas down to your clinicians and other caregivers. Turn them into practical changes that everyone can make within their own sphere of influence. Then, communicate up to hospitals and payers. Tell them about the impact your brand of quality care can have on their problems and on their bottom line."
Change is inevitable, it is already here, and it is accelerating. But it does not forebode doomsday. Some healthcare at home providers will thrive on it.
©2015 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org