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December 2006

Home Health Disease Management

Home Health is the “perfect fit” for Disease Management. There are four critical factors that set the stage for the provision of Disease Management by Home Health providers. The Home Health setting affords opportunities in Disease Management that are unique. 

Home Health can decrease the overall spending of health care dollars for chronic care while maintaining quality. A study led by Bruce Leff, MD, of Johns Hopkins University of Medicine found that hospital-level care provided in the home is effective, is feasible and costs less than the same care delivered in a hospital with similar quality standards. A 2005 RAND Corporation study found that the care provided in the home for patients with knee replacement yielded better quality outcomes and was more cost- effective than in-patient care for this same condition. A 2004 study conducted by the National Institute of Nursing Research also found that when specialized care was provided to in-patients who returned home with this same specialized care, patients had fewer return hospitalizations and reported a better quality of life, resulting in a savings to Medicare of
close to 38%.

Home Health providers generate a standardized set of risk-adjusted quality outcomes across the industry that is compared to a national reference data base. Some of these include acute care hospitalization, improvement in oral medication management, improvement in dyspnea and discharge to the community. Many providers have demonstrated a decrease in acute care hospitalizations of patients while under a home health plan of care. Achieving a national home health Acute Care Hospitalization target rate in one year can save the Medicare Trust Fund an estimated 356.4 million dollars.

Providing care in the patient’s place of residence affords advantages not found in other healthcare settings. Clinicians can observe first-hand the barriers patients face, and caregivers and can make recommendations accordingly. Non-adherence to treatment regime can be better understood and assistance can be offered through collaborating with the patients and families in their own residences.

Home health outcomes can be shared across the healthcare settings and used to manage patients collaboratively with an eye toward improved care quality and cost containment across the healthcare continuum. 

OutcomeLogics, Inc. (OLI) of Knoxville, Tennessee conducted a recent Home Health Disease Management Readiness Survey in the second half of 2005. Responses were received from 620 home health providers of all sizes across the United States and the District of Columbia, representing for-profit, non-profit hospital-based and free-standing agencies. OLI’s survey described the home health disease management readiness of respondents according to:

  1. Level of stated priority for implementing disease management
  2. Use  of care standards with outcome measurements
  3. Use of point of care technology and telemonitoring
  4. Collaborative effort established across healthcare settings 
  5. Technological capability to correlate clinical outcomes with financial outcomes by diagnosis 

With the Centers for Medicare and Medicaid Services’ (CMS) emphasis on collaborating across healthcare settings, there is a great interest within the home health community to enter the disease management arena. How ready is the home health provider to offer a disease management approach to care? What challenges lie ahead? Click here for references cited and the full white paper.

Melinda Huffman
Principal Consultant, OUTCOMELogics Inc.

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