THE FUTURE OF HOME HEALTH PROJECT:
Developing the Framework for Health Care at Home In addition to providing high-quality care to vulnerable patient populations, home healthcare offers the least costly option for patients and the healthcare system, particularly in postacute care. As the baby boom generation ages, policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. The Alliance for Home Health Quality and Innovation seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. This article describes the initiative and invites readers to provide comments and suggestions.
I
n the midst of an evolving healthcare landscape, the home healthcare community finds itself at a crossroads. The demographic tide of baby boomers is aging into the Medicare program at the same time policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. Significant cuts in home healthcare payment rates are occurring as increasing numbers of seniors and people with disabilities are in need of access to quality home healthcare. Moreover, there is increasing g interest among g
T Teresa Lee, L JD, JD MPH, MPH and d Jennifer Schiller, BA
84
Volume 33
|
Number 2
www.homehealthcarenow.org
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
payers and policymakers in leveraging home-based approaches to care as a means of achieving costeffective care in the most clinically appropriate setting. This article will describe these and other key issues, and how a project on the future of home healthcare seeks to improve understanding of the role and relevance of home healthcare in the future for older Americans and those with disabilities.
Home Healthcare Today Home healthcare agencies (HHAs) are currently the only providers who are certified specifically by Medicare to treat patients in their homes. It is well known that to qualify for the Medicare home healthcare benefit, patients must (a) be homebound, (b) need intermittent skilled nursing and/ or therapy services, and (c) be under the care of a physician and need reasonable and necessary home healthcare services that have been certified by a physician and established in a 60-day plan of care (Centers for Medicare and Medicaid Services, 1989). Given these requirements, it’s unsurprising that Medicare home healthcare beneficiaries are generally poorer, sicker, and living with more chronic conditions than the average Medicare patient. Nearly 25% of Medicare home healthcare patients are aged 85 years or above, and almost 60% of Medicare home healthcare patients are older than 75 years of age. By comparison, only about 40% of the general Medicare population is aged 75 years or older. Additionally, 62.5% of Medicare home healthcare patients have incomes of less than $25,000 per year as compared with 49.5% of the general Medicare population. More than four in every five Medicare home healthcare patients (83.2%) suffer from three or more chronic conditions, compared to three out of every five (59.8%) in the general Medicare population. These patients are also more likely to report fair or poor health (45.8%) than the general Medicare population (26.6%). Home healthcare patients are also more likely than the average Medicare beneficiary to live alone and have two or more limitations in their activities of daily living (Avalere Health LLC, 2013). Home healthcare’s intuitive value proposition— that home healthcare offers quality care that is cost effective and patient preferred—is borne out by data. More often than not, patient outcomes improve during the home healthcare episode. Data from Home Health Compare show that after a home healthcare episode of care, 89% of wounds improved or healed after an operation for patients
February 2015
following a home healthcare episode. Additional data show that 68% of patients had less pain when moving around, 68% get better at bathing, and 65% had improved breathing after receiving home healthcare (Home Health Compare, 2014). In addition to providing high-quality care to vulnerable patient populations, home healthcare often offers the least costly option for patients and the healthcare system, particularly in the context of postacute care. Medicare expenditures for a patient receiving home heathcare following a hospital stay are nearly $8,000 less than average among all settings ($20,345 vs. $28,294) (Dobson et al., 2012a). For patients receiving care following a major joint replacement, the average first setting home healthcare payment is $18,068 versus an average episode payment of $23,479 (Dobson et al., 2012b). Finally, home healthcare is not only a safe, effective, and less costly means of providing care, it is also the setting generally preferred by older Americans and persons with disabilities. According to a report from the Demand Institute on the shifting nature of housing demand in America, 78% of seniors aged 65 years and older do not plan to move (Keely et al., 2012). Despite the value proposition home healthcare offers patients and the U.S. healthcare system, the home healthcare community faces a number of challenges. Concerns about rising costs, variation in usage, and program integrity are some of the factors that have led policymakers in Washington to cut payment rates for home healthcare services. Moreover, the siloed approach to traditional Medicare payment emphasizes volume over value and perpetuates fragmented care. This fragmented approach to payment provides little incentive for care coordination across settings. Instead, a series of reforms may encourage the use of mixed services and settings to improve care and lower cost. Additional concerns exist with regard to the structure of the Medicare home healthcare benefit. Although patients receiving home healthcare may initially be homebound, they may lose this status after their condition improves after receiving care. This requirement limits a patient’s ability to receive longitudinal services simply because the patient is no longer classified as homebound, possibly impeding the support and care that the patient needs. Similarly, the skilled care requirement limits the scope of care a patient receives. Often patients need social and behavioral support
Home Healthcare Now
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
85
Significant cuts in home healthcare payment rates are occurring while increasing numbers of seniors and people with disabilities are in need of access to quality home healthcare. that is critical for health outcomes, but may not technically be considered skilled care. Other barriers to appropriately optimizing home healthcare include a lack of adequate support and infrastructure for an aging population, especially for those who wish to age in place. A lack of adequate caregiving support, housing, meals, and transportation all present challenges to allowing older Americans to age in place and, in turn, providing healthcare at home. The current patchwork system of Medicaid, state and local programs, and out-of-pocket expenses puts a heavy burden on patients and families to assemble the multiple facets of care so that they can be independent at home. These hurdles make utilization of institutional care more likely than it should be.
Harbingers of the Future: Emerging Models of Care and Technology Despite the challenges facing HHAs, a number of new models of care delivery are suggestive of what the future holds for high-value healthcare provided in the home. Accountable care organizations, bundled payment arrangements, the Independence at Home Demonstration, the Veterans Affairs HomeBased Primary Care Program, community-based care transitions, and the Program of All-Inclusive Care for the Elderly are all examples of innovative models of care delivery, which may be using home healthcare as part of their strategy to influence healthcare delivery reform in the United States (Dobson et al., 2014). Although different, all of the aforementioned programs emphasize the goal of achieving the Triple Aim of: (a) improving population health, (b) improving patient experience, and (c) lowering per-capita cost of care (Institute for Healthcare Improvement, 2012). Technology also plays a crucial role in defining the role of home healthcare in the future. Remote monitoring, phone calls, mobile phone applications, health information technology, inhome therapy, and diagnostic technologies are just some of the ways technology is enabling
86
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innovation for the future of healthcare delivery in the home (Landers, 2013).
Developing a Strategic Framework for the Future So how does home healthcare get from the current state to a brighter future where home healthcare is appropriately optimized in the effort to achieve the Triple Aim? To address the outlined concerns and present opportunities for the future of care at home, the Alliance for Home Health Quality and Innovation (the Alliance) seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. The Alliance is a 501(c)(3) nonprofit organization dedicated to the mission of leading and supporting research and education efforts on the value of home healthcare. It is an organization with a diverse membership of home healthcare providers, associations, and organizations. Of particular interest to this publication’s readership, the Alliance has been appreciative of the leadership of, and coordination with, the Visiting Nurse Associations of America, in addition to other prominent organizations that support the Alliance’s mission. A full listing of the Alliance’s membership can be found on the Alliance’s Web site at http://www.ahhqi.org. The research-based strategic framework cited above will be the culmination of the Alliance’s Future of Home Health (FOHH) project, which aims to improve the understanding of how home healthcare is currently used, and how it will be used in the future for seniors and Americans with disabilities. In constructing the project, the Alliance laid out a four-step approach utilizing a number of different components executed over a multiyear timeframe that began in early 2014. The FOHH project grew out of a desire from the home healthcare community to better define and communicate its position in the current healthcare system, as well as its role in the future. In doing so, the Alliance looked to the family medicine community’s 2004 “Future of Family Medicine” project (Martin et al. 2004). Released in the Annals of Family Medicine, the project laid out a strategy for better meeting the needs of patients served by renovating the structure of family medicine in the United States, and ultimately served as a model that is now called the Patient-Centered Medical Home. Recognizing the similar crossroads the home healthcare community currently faces, and keeping
www.homehealthcarenow.org
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
in mind the healthcare system goals of the Triple Aim, the Alliance has undertaken the FOHH project to better understand the current and evolving state of home healthcare to provide context, which will help inform understanding of the role of home healthcare in the future of the U.S. healthcare system. The project is organized in four phases: (a) a white paper on the role of home healthcare in the healthcare system; (b) an Alliance-sponsored Institute of Medicine (IOM) and National Research Council (NRC) workshop; (c) a symposium of key stakeholders; and (d) a research-based strategic framework stemming from the previous three phases. Kicking off the project was a white paper on the current state of home healthcare and the issues giving rise to the project. The white paper was released at a Capitol Hill briefing in May and provides a foundation for the project moving forward. Speakers at the briefing addressed the role of home healthcare in achieving the Triple Aim. In late September 2014, The IOM/NRC’s Forum on Aging, Disability, & Independence held a workshop on the future of home healthcare. The workshop dove into the current state of home healthcare and the evolving role of Medicare home healthcare and other forms of home-based care in the context of the Triple Aim. In support of these themes, the workshop looked at: innovation and emerging models of care; needs related to infrastructure, workforce, research, measurement, and technology; and policy reform and communications strategies. The workshop helped to identify key themes for the role of Medicare home healthcare and what its evolution in the future should look like. A formal workshop summary will be published by the IOM and NRC, providing documentation of the presentations, discussion, and themes from the 2-day workshop, and will be used to provide additional context to the subsequent work in the FOHH project. Following the IOM/NRC workshop, the Alliance hosted a symposium in January in Washington, DC, gathering key stakeholders to discuss key delivery system reforms and emerging models of care critical to the future of home healthcare. Finally, the Alliance will publish its research-based strategic framework for the future of home healthcare later in 2015. The framework will seek to address the critical issues raised during the early components of the project and provide a roadmap for the future of home healthcare in America.
February 2015
As part of the project, the home healthcare community and all interested parties are encouraged to weigh in on any aspect of the project. Up-to-date project information will also be made available on the Alliance’s Web site at http://ahhqi. org/home-health/future-project, with information on how to contact Alliance staff with any comments, questions, or ideas regarding the project. The Alliance believes that with an investment in research, analysis, and discussion, we can begin to answer key questions about the value of home healthcare and provide a clearer picture of how to appropriately optimize its potential for patients, payers, and providers in the future. Teresa Lee, JD, MPH, is Executive Director with the Alliance for Home Health Quality and Innovation, Washington, DC. Jennifer Schiller, is Director of Communications with the Alliance for Home Health Quality and Innovation, Washington, DC. The authors declare no conflicts of interest. Address for correspondence: Jennifer Schiller, P.O. Box 7319, Washington, D.C. 20044 ([email protected]). DOI:10.1097/NHH.0000000000000193
REFERENCES Avalere Health LLC. (2013, August). Home health chartbook. Retrieved from http://ahhqi.org/images/uploads/20130906_Home_ Health_Chartbook_FINAL.pdf (Source for portions quoted: Medicare Current Beneficiary Survey, Access to Care file 2011). Centers for Medicare and Medicaid Services. (1989). Medicare conditions for participation for home health agencies. Retrieved from http://www.ecfr.gov/cgi-bin/text-idx?SID=4694e965586b91e64 d6ace32058baafa&node=42:5.0.1.1.3&rgn=div5 Dobson, A., DaVanzo, J. E., El-Gamil, A., Heath, S., Shimer, M., Berger, G., …, Freeman, J. M. (2012a). Improving health care quality and efficiency (“final report”): Clinically Appropriate and Cost-Effective Placement (CACEP) Project. Retrieved from http://ahhqi.org/images/pdf/cacep-report.pdf Dobson, A., El-Gamil, A., Heath, S., Manolov, N., & DaVanzo, J. (2014, January). Bundling and Coordinating Post-Acute Care (BACPAC): Toolkit for preliminary modeling and implementation. Retrieved from http://ahhqi.org/images/pdf/bacpac-dda-final-report.pdf Dobson, A., El-Gamil, A., Heath, S., Wang, J., Berger, G., & DaVanzo, J. E. (2012b, October). Clinically Appropriate and Cost-Effective Placement (CACEP) Project working paper series, Working Paper #2: Baseline statistics of Medicare payments by episode type for select MS-DRGs and chronic conditions. Retrieved from http://ahhqi.org/images/pdf/cacep-wp2-baselines.pdf Home Health Care-National Data: The national averages for critical quality measures of Home Health Agencies. (2014, October). https://data.medicare.gov/Home-Health-Compare/HomeHealth-Care-National-Data/97z8-de96 Institute for Healthcare Improvement. (2012). IHI Triple Aim Initiative. Retrieved from http://www.ihi.org/engage/initiatives/TripleAim/ Pages/default.aspx Keely, L., van Ark, B., Levanon, G., & Burbank, J. (2012). The shifting nature of U.S. housing demand. Retrieved from http:// www.demandinstitute.org/sites/default/files/blog-uploads/ tdihousingdemand.pdf Landers, S. H. (2013). The case for “connected health” at home. Cleveland Clinic Journal of Medicine, 80(Electronic Suppl. 1), eS27-eS29. Martin, J. C., Avant RF, Bowman MA, Bucholtz JR, Dickinson JR, Evans KL, ..., (2004). The Future of Family Medicine: a collaborative project of the family medicine community. Annals of Family Medicine, 2(Suppl. 1), S3-S32.
Home Healthcare Now
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
87
Developing the Framework for Health Care at Home In addition to providing high-quality care to vulnerable patient populations, home healthcare offers the least costly option for patients and the healthcare system, particularly in postacute care. As the baby boom generation ages, policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. The Alliance for Home Health Quality and Innovation seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. This article describes the initiative and invites readers to provide comments and suggestions.
I
n the midst of an evolving healthcare landscape, the home healthcare community finds itself at a crossroads. The demographic tide of baby boomers is aging into the Medicare program at the same time policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. Significant cuts in home healthcare payment rates are occurring as increasing numbers of seniors and people with disabilities are in need of access to quality home healthcare. Moreover, there is increasing g interest among g
T Teresa Lee, L JD, JD MPH, MPH and d Jennifer Schiller, BA
84
Volume 33
|
Number 2
www.homehealthcarenow.org
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
payers and policymakers in leveraging home-based approaches to care as a means of achieving costeffective care in the most clinically appropriate setting. This article will describe these and other key issues, and how a project on the future of home healthcare seeks to improve understanding of the role and relevance of home healthcare in the future for older Americans and those with disabilities.
Home Healthcare Today Home healthcare agencies (HHAs) are currently the only providers who are certified specifically by Medicare to treat patients in their homes. It is well known that to qualify for the Medicare home healthcare benefit, patients must (a) be homebound, (b) need intermittent skilled nursing and/ or therapy services, and (c) be under the care of a physician and need reasonable and necessary home healthcare services that have been certified by a physician and established in a 60-day plan of care (Centers for Medicare and Medicaid Services, 1989). Given these requirements, it’s unsurprising that Medicare home healthcare beneficiaries are generally poorer, sicker, and living with more chronic conditions than the average Medicare patient. Nearly 25% of Medicare home healthcare patients are aged 85 years or above, and almost 60% of Medicare home healthcare patients are older than 75 years of age. By comparison, only about 40% of the general Medicare population is aged 75 years or older. Additionally, 62.5% of Medicare home healthcare patients have incomes of less than $25,000 per year as compared with 49.5% of the general Medicare population. More than four in every five Medicare home healthcare patients (83.2%) suffer from three or more chronic conditions, compared to three out of every five (59.8%) in the general Medicare population. These patients are also more likely to report fair or poor health (45.8%) than the general Medicare population (26.6%). Home healthcare patients are also more likely than the average Medicare beneficiary to live alone and have two or more limitations in their activities of daily living (Avalere Health LLC, 2013). Home healthcare’s intuitive value proposition— that home healthcare offers quality care that is cost effective and patient preferred—is borne out by data. More often than not, patient outcomes improve during the home healthcare episode. Data from Home Health Compare show that after a home healthcare episode of care, 89% of wounds improved or healed after an operation for patients
February 2015
following a home healthcare episode. Additional data show that 68% of patients had less pain when moving around, 68% get better at bathing, and 65% had improved breathing after receiving home healthcare (Home Health Compare, 2014). In addition to providing high-quality care to vulnerable patient populations, home healthcare often offers the least costly option for patients and the healthcare system, particularly in the context of postacute care. Medicare expenditures for a patient receiving home heathcare following a hospital stay are nearly $8,000 less than average among all settings ($20,345 vs. $28,294) (Dobson et al., 2012a). For patients receiving care following a major joint replacement, the average first setting home healthcare payment is $18,068 versus an average episode payment of $23,479 (Dobson et al., 2012b). Finally, home healthcare is not only a safe, effective, and less costly means of providing care, it is also the setting generally preferred by older Americans and persons with disabilities. According to a report from the Demand Institute on the shifting nature of housing demand in America, 78% of seniors aged 65 years and older do not plan to move (Keely et al., 2012). Despite the value proposition home healthcare offers patients and the U.S. healthcare system, the home healthcare community faces a number of challenges. Concerns about rising costs, variation in usage, and program integrity are some of the factors that have led policymakers in Washington to cut payment rates for home healthcare services. Moreover, the siloed approach to traditional Medicare payment emphasizes volume over value and perpetuates fragmented care. This fragmented approach to payment provides little incentive for care coordination across settings. Instead, a series of reforms may encourage the use of mixed services and settings to improve care and lower cost. Additional concerns exist with regard to the structure of the Medicare home healthcare benefit. Although patients receiving home healthcare may initially be homebound, they may lose this status after their condition improves after receiving care. This requirement limits a patient’s ability to receive longitudinal services simply because the patient is no longer classified as homebound, possibly impeding the support and care that the patient needs. Similarly, the skilled care requirement limits the scope of care a patient receives. Often patients need social and behavioral support
Home Healthcare Now
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
85
Significant cuts in home healthcare payment rates are occurring while increasing numbers of seniors and people with disabilities are in need of access to quality home healthcare. that is critical for health outcomes, but may not technically be considered skilled care. Other barriers to appropriately optimizing home healthcare include a lack of adequate support and infrastructure for an aging population, especially for those who wish to age in place. A lack of adequate caregiving support, housing, meals, and transportation all present challenges to allowing older Americans to age in place and, in turn, providing healthcare at home. The current patchwork system of Medicaid, state and local programs, and out-of-pocket expenses puts a heavy burden on patients and families to assemble the multiple facets of care so that they can be independent at home. These hurdles make utilization of institutional care more likely than it should be.
Harbingers of the Future: Emerging Models of Care and Technology Despite the challenges facing HHAs, a number of new models of care delivery are suggestive of what the future holds for high-value healthcare provided in the home. Accountable care organizations, bundled payment arrangements, the Independence at Home Demonstration, the Veterans Affairs HomeBased Primary Care Program, community-based care transitions, and the Program of All-Inclusive Care for the Elderly are all examples of innovative models of care delivery, which may be using home healthcare as part of their strategy to influence healthcare delivery reform in the United States (Dobson et al., 2014). Although different, all of the aforementioned programs emphasize the goal of achieving the Triple Aim of: (a) improving population health, (b) improving patient experience, and (c) lowering per-capita cost of care (Institute for Healthcare Improvement, 2012). Technology also plays a crucial role in defining the role of home healthcare in the future. Remote monitoring, phone calls, mobile phone applications, health information technology, inhome therapy, and diagnostic technologies are just some of the ways technology is enabling
86
Volume 33
|
Number 2
innovation for the future of healthcare delivery in the home (Landers, 2013).
Developing a Strategic Framework for the Future So how does home healthcare get from the current state to a brighter future where home healthcare is appropriately optimized in the effort to achieve the Triple Aim? To address the outlined concerns and present opportunities for the future of care at home, the Alliance for Home Health Quality and Innovation (the Alliance) seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. The Alliance is a 501(c)(3) nonprofit organization dedicated to the mission of leading and supporting research and education efforts on the value of home healthcare. It is an organization with a diverse membership of home healthcare providers, associations, and organizations. Of particular interest to this publication’s readership, the Alliance has been appreciative of the leadership of, and coordination with, the Visiting Nurse Associations of America, in addition to other prominent organizations that support the Alliance’s mission. A full listing of the Alliance’s membership can be found on the Alliance’s Web site at http://www.ahhqi.org. The research-based strategic framework cited above will be the culmination of the Alliance’s Future of Home Health (FOHH) project, which aims to improve the understanding of how home healthcare is currently used, and how it will be used in the future for seniors and Americans with disabilities. In constructing the project, the Alliance laid out a four-step approach utilizing a number of different components executed over a multiyear timeframe that began in early 2014. The FOHH project grew out of a desire from the home healthcare community to better define and communicate its position in the current healthcare system, as well as its role in the future. In doing so, the Alliance looked to the family medicine community’s 2004 “Future of Family Medicine” project (Martin et al. 2004). Released in the Annals of Family Medicine, the project laid out a strategy for better meeting the needs of patients served by renovating the structure of family medicine in the United States, and ultimately served as a model that is now called the Patient-Centered Medical Home. Recognizing the similar crossroads the home healthcare community currently faces, and keeping
www.homehealthcarenow.org
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
in mind the healthcare system goals of the Triple Aim, the Alliance has undertaken the FOHH project to better understand the current and evolving state of home healthcare to provide context, which will help inform understanding of the role of home healthcare in the future of the U.S. healthcare system. The project is organized in four phases: (a) a white paper on the role of home healthcare in the healthcare system; (b) an Alliance-sponsored Institute of Medicine (IOM) and National Research Council (NRC) workshop; (c) a symposium of key stakeholders; and (d) a research-based strategic framework stemming from the previous three phases. Kicking off the project was a white paper on the current state of home healthcare and the issues giving rise to the project. The white paper was released at a Capitol Hill briefing in May and provides a foundation for the project moving forward. Speakers at the briefing addressed the role of home healthcare in achieving the Triple Aim. In late September 2014, The IOM/NRC’s Forum on Aging, Disability, & Independence held a workshop on the future of home healthcare. The workshop dove into the current state of home healthcare and the evolving role of Medicare home healthcare and other forms of home-based care in the context of the Triple Aim. In support of these themes, the workshop looked at: innovation and emerging models of care; needs related to infrastructure, workforce, research, measurement, and technology; and policy reform and communications strategies. The workshop helped to identify key themes for the role of Medicare home healthcare and what its evolution in the future should look like. A formal workshop summary will be published by the IOM and NRC, providing documentation of the presentations, discussion, and themes from the 2-day workshop, and will be used to provide additional context to the subsequent work in the FOHH project. Following the IOM/NRC workshop, the Alliance hosted a symposium in January in Washington, DC, gathering key stakeholders to discuss key delivery system reforms and emerging models of care critical to the future of home healthcare. Finally, the Alliance will publish its research-based strategic framework for the future of home healthcare later in 2015. The framework will seek to address the critical issues raised during the early components of the project and provide a roadmap for the future of home healthcare in America.
February 2015
As part of the project, the home healthcare community and all interested parties are encouraged to weigh in on any aspect of the project. Up-to-date project information will also be made available on the Alliance’s Web site at http://ahhqi. org/home-health/future-project, with information on how to contact Alliance staff with any comments, questions, or ideas regarding the project. The Alliance believes that with an investment in research, analysis, and discussion, we can begin to answer key questions about the value of home healthcare and provide a clearer picture of how to appropriately optimize its potential for patients, payers, and providers in the future. Teresa Lee, JD, MPH, is Executive Director with the Alliance for Home Health Quality and Innovation, Washington, DC. Jennifer Schiller, is Director of Communications with the Alliance for Home Health Quality and Innovation, Washington, DC. The authors declare no conflicts of interest. Address for correspondence: Jennifer Schiller, P.O. Box 7319, Washington, D.C. 20044 ([email protected]). DOI:10.1097/NHH.0000000000000193
REFERENCES Avalere Health LLC. (2013, August). Home health chartbook. Retrieved from http://ahhqi.org/images/uploads/20130906_Home_ Health_Chartbook_FINAL.pdf (Source for portions quoted: Medicare Current Beneficiary Survey, Access to Care file 2011). Centers for Medicare and Medicaid Services. (1989). Medicare conditions for participation for home health agencies. Retrieved from http://www.ecfr.gov/cgi-bin/text-idx?SID=4694e965586b91e64 d6ace32058baafa&node=42:5.0.1.1.3&rgn=div5 Dobson, A., DaVanzo, J. E., El-Gamil, A., Heath, S., Shimer, M., Berger, G., …, Freeman, J. M. (2012a). Improving health care quality and efficiency (“final report”): Clinically Appropriate and Cost-Effective Placement (CACEP) Project. Retrieved from http://ahhqi.org/images/pdf/cacep-report.pdf Dobson, A., El-Gamil, A., Heath, S., Manolov, N., & DaVanzo, J. (2014, January). Bundling and Coordinating Post-Acute Care (BACPAC): Toolkit for preliminary modeling and implementation. Retrieved from http://ahhqi.org/images/pdf/bacpac-dda-final-report.pdf Dobson, A., El-Gamil, A., Heath, S., Wang, J., Berger, G., & DaVanzo, J. E. (2012b, October). Clinically Appropriate and Cost-Effective Placement (CACEP) Project working paper series, Working Paper #2: Baseline statistics of Medicare payments by episode type for select MS-DRGs and chronic conditions. Retrieved from http://ahhqi.org/images/pdf/cacep-wp2-baselines.pdf Home Health Care-National Data: The national averages for critical quality measures of Home Health Agencies. (2014, October). https://data.medicare.gov/Home-Health-Compare/HomeHealth-Care-National-Data/97z8-de96 Institute for Healthcare Improvement. (2012). IHI Triple Aim Initiative. Retrieved from http://www.ihi.org/engage/initiatives/TripleAim/ Pages/default.aspx Keely, L., van Ark, B., Levanon, G., & Burbank, J. (2012). The shifting nature of U.S. housing demand. Retrieved from http:// www.demandinstitute.org/sites/default/files/blog-uploads/ tdihousingdemand.pdf Landers, S. H. (2013). The case for “connected health” at home. Cleveland Clinic Journal of Medicine, 80(Electronic Suppl. 1), eS27-eS29. Martin, J. C., Avant RF, Bowman MA, Bucholtz JR, Dickinson JR, Evans KL, ..., (2004). The Future of Family Medicine: a collaborative project of the family medicine community. Annals of Family Medicine, 2(Suppl. 1), S3-S32.
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Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
87
