Delivering the Right Care at the Right Time

The Institute of Medicine defines appropriate and affordable care as “Delivering the right care at the right time with the right provider in the right setting.” Technology enabled home health providers like Pyramid Home Health Services in partnership with Patient’s Physicians represent a uniquely well suited team to ensure delivery of the type of maximally coordinated and effective care contemplated in this definition. Within the operational perimeters of Affordable Care Act (ACA), these partnerships provide a distinct advantage for both Physician and Home Health company and, more importantly, for patients.

Nearly a quarter of Medicare beneficiaries have five or more chronic conditions. These individuals account for approximately two thirds of total Medicare Spending. As we’ve discussed in earlier blog posts, the care provided for these individuals, especially where they are dual eligible, is largely uncoordinated and disjointed. This is one reason why this population of patients is fully 100-times more likely to experience a preventable hospitalization than non- chronically ill Medicare beneficiaries. Under the ACA, failure to better coordinate and manage these patients’ care has a huge price tag for providers; particularly hospitals, in the form of readmission penalties and forgone revenue from “Shared Savings” opportunities. Additionally, failure to deliver quality outcomes can imperil long standing referral relationships as “At Risk” providers can ill afford to be further imperiled by low performing partners. Through the application of these economic consequences, the ACA is very definitely driving a strong shift up and down the continuum of care toward delivering desired outcomes at lower cost.

Embedded in the ACA are multiple opportunities for Physicians and Home Health Companies to work together to deliver better outcomes for chronically ill patients. One of the first areas evidencing this opportunity can be found in numerous Independence at Home Demonstration (IAH) programs. Basically IAH are Physician, Nurse Practitioner or Physician Assistant led house call programs. Under IAH guidelines providers are paid for their services but they have the opportunity to share in 80% of Medicare’s savings after meeting a minimum 5% total savings of the fee for service average for beneficiaries in their practice region. While the IAH demonstration specifically is only permitted to enroll up to 10,000 Medicare beneficiaries nationwide; its pay for performance metrics are embodied in numerous other ACA initiatives.

Where Medicaid is concerned, the ACA establishes the opportunity for State Medicaid plans to create Health Homes. Eligible beneficiaries are those who qualify for medical assistance under a state plan or waiver and who have two or more chronic conditions or who have a chronic illness and a concomitant mental health condition. We in Missouri were the first in the nation to establish health home programs and today they are operating within FQHC and CMHC state-wide. These initiatives couple per member per month payment for care coordination with the opportunity for states and providers to share in the Medicare savings resulting from better coordinated care.

The ACA additionally funds a vastly expanded national preventive health initiative. Annual physical examinations, health risk assessments, and personalized disease prevention services are all mandated to be fully covered for all Medicare beneficiaries.

In the healthcare landscape molded by the ACA, Pyramid Home Health Services represents a perfect practice extender for Missouri Primary Care Physicians. With new patients resulting from expanded insurance coverage generally as well as the aging of the baby boomer population, it’s going to be tough for Primary Care Physicians to meet the increased demands on their time. Through the use of Pyramid Home Health Services’ Nurse Practitioners, RN, and HIPPA compliant Tele-Health portals, these practitioners are enabled to see patients at home without incurring the expense and inefficiency of personally travelling from house to house. When cast from their offices these interactions are billable per the standard 2014 Physician Fee Schedule; so with Pyramid Home Health Services, Physicians can focus on those patients who are most critically in need of their personal, physical presence while also meeting the demands of their growing patient base by treating many of those patients in the comfort of their own home.

Where Physicians are participating in population health management strategies like IAH, Health Homes and under risk based contracts with managed care entities, utilizing Pyramid Home Health Services staff and its various monitoring technologies provides a powerful tool to identify issues prior to their becoming ER visits and hospitalizations. Where these relationships are concerned, Pyramid Home Health Services can work with these providers on a shared risk or per member, per month basis. Including in these arrangements are various levels of home monitoring, laboratory, referral to ancillary services and our MTM certified Pharmacists.

An effective partnership with Pyramid Home Health Services offers Missouri Physicians the opportunity to further their patient relationships by making themselves and their practices more available to all patients all the time; which is exactly in-line with the policy push implicit in the ACA, “To deliver the right care at the right time with the right provider in the right setting.”

If you are a Physician in Missouri and would like to talk further about how we can help you extend your practice into your patient’s home, visit Pyramid Home Health Services online at or call us at 888-880-6565.

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