Medicare has paid for home health since 1965. Other payers cover care in the home, but over the past 45 years the Medicare patient who needed the skill set of the home health nurse has gotten care exclusively from Medicare certified home health agencies. With the Affordable Care Act on our near horizon Medicare is preparing to split that care at home into a number of different models. A recent blog article by healthcare thought leader Ed O’Neill, PhD, indicated part of the intent of the Affordable Care Act was to provide the framework for what the authors of the legislation hope will be ten thousand new ‘mini-models’ from which will come a much more effective and efficient system of care, prevention and wellness.
The passage of Affordable Care Act, parts of which are already being implemented, means that ‘disruptive innovation’ is on the very near horizon for healthcare providers. And in some cases it has already arrived. Clayton Christensen, a Harvard DBA, coined the term ‘disruptive innovation’ in 1997 in his book The Innovator’s Dilemma. That book describes the breakdown of the existing revenue streams and relationships by what Christensen refers to as the disruptive innovation that occurred in the disk drive industry in the 80’s and 90’s. In his introduction he points to Sears, Digital and Xerox as examples of mega-corporations that failed because they did not adapt to the ‘disruptive innovations’ of smaller companies, many on the fringes of retail and technology compared to the behemoths, that eventually took away the majority of their business.
Fast forward to 2009 and Christensen and two physician coauthors release The Innovator’s Prescription. The book has numerous examples and ideas about ‘disruptive’ approaches to our ailing health system. Christensen argues that escalating costs, poor access, and care outcomes that rank near 30th among industrialized nations all make our nation’s health system ripe for disruption. Chapter Four is entitled “Disruptive Solutions for the Care of Chronic Disease”, and should be mandatory reading for all homecare providers.
Over the coming weeks the HomeCare Association of Louisiana will share a series of links to new ‘disruptive’ models of care that may be among those innovations that will drive our future health system. We have heard about care transitions, chronic care management, health coaching, medication management, pay for performance and other approaches to improving care over recent years. New models in which those approaches to care will be provided include pilots and demonstration projects that are ongoing or soon to begin: the Patient Centered Medical Home, Accountable Care Organizations, post acute bundling, the Independence at Home Act, Value Based Purchasing, and more. In Louisiana our state is preparing to ‘outsource’ Medicaid to managed care companies that will try to use new approaches to care. Other innovative Medicaid waiver models will include the use of technology where appropriate, assisting with home modifications, and other ‘dynamic budgeting’ approaches to address the fiscal challenges of caring for an aging, chronically ill population. We hope you find these links and ideas helpful and thought provoking as we look with both uncertainty and hope to a new era of healthcare.
The Implementation of New Models of Care: Q&A with Iowa Health System CEO Bill Leaver
This article gives one hospital executive’s view of new models of care, accountable care organizations, chronic care, coordinated care, home health and tele-health. He mentions that 50% of healthcare costs are chronic care, while AARP indicates chronic disease costs are actually 83%. But this gives you an idea of how some hospital executives view models that will require bundling and innovative approaches to care management.
