As AlayaCare has grown, we’ve had the privilege of observing how health systems around the world are organizing to keep seniors and chronically or acutely ill patients receiving care and convalescing in their preferred setting: at home. Everywhere we look, home care is growing at double-digit percentages. A key driver: the fact that delivering care where clients/patients want to receive it just makes great economic sense.
Last year, I recapped our key predictions for home care in 2018 -- and it’s safe to say that many have come to fruition: from the business imperative of employee retention to the importance of schedule and route optimization. Many of these issues are ongoing and will continue to affect the landscape into 2019 and beyond.
Looking to the new year, I foresee three specific themes that will be central to our growing industry: caregiver engagement, whole-person care, and home care’s pursuit of the right technology.
A great experience for caregivers = happier clients
Labour shortages across the sector have meant that home care providers are dedicating considerable attention to caregiver experience. Optimization schedules to satisfy caregiver (and client) preferences has become a major focus area for home healthcare providers. Minimizing travel time and providing contiguous schedules with enough consistent hours to achieve a stable income has become paramount to attract workers to the sector. And, as importantly, for agencies to retain them.
Despite such efforts, turnover in the U.S. home care industry alone grew from 39.4% in 2009 to 65.7% last year according to Home Care Pulse. Our clients are telling us that a newfound focus on caregivers’ quality of life has been the key to unlocking great care. For example, at Nurse Next Door (who are truly fanatical about delivering a great client experience), they recognize that Employee Net Promoter Scores (eNPS) and Client Net Promoter Scores (NPS) move in sync. The latter are a way of aggregating answers to a simple query: How likely are you to refer a friend/colleague to this home healthcare provider?
Integration of Clinical Care with Personal Care
A second trend for 2019 is the growing realization that, to improve patient outcomes, personal care is often as important as clinical care. For example, when working with a senior with at least one chronic illness, a companion who mitigates social isolation, helps prepare nutritious meals, and keeps a tidy home is as relevant to keeping that client out of hospital as is nursing intervention.
In the U.S., Medicare & Medicaid Services (CMS) is putting its money behind this idea by embedding non-skilled in-home care in Medicare Advantage plans. In Australia and other markets that have moved towards client-directed care, clients are already making this choice. Now, health systems that separated care prescription from care delivery (often with the assessments and resource allocation coming from case managers in the public system while care delivery is handled by private agencies) are recognizing that those delivering care should be empowered to develop plans that integrate skilled and non-skilled care.
This trend will continue, and funding models across the world are to shift along with it.
Innovative funding models for integrated remote monitoring
Lately, medical literature is supporting the case for remote patient monitoring (RPM) as an intervention to improve outcomes for chronically ill seniors. Most thought leaders in this domain today have turned their attention away from if RPM can work to how to fund these interventions and what parts of the health-care system are prime to deliver RPM programs.
In jurisdictions where RPM has sustained early momentum -- such as the Ontario Telemedicine Network’s COPD and heart failure programs -- RPM has been set up as yet another silo of care. Less inertia to get started, but less integrated and ultimately less scalable. In 2019, we will see funding and delivery models catch up to the idea that RPM within the business of home care is an efficient way to combine health coaching with hands-on care.
This trend is taking a few forms. In Australia, for one, the move toward client-direct care (CDC) has allowed patients themselves to allocate resources towards interventions they find valuable. RPM has turned out to be near the top of the list. By definition, this leads to multi-modal care spanning in-person, virtual, and software-assisted care. When AI augments the clinical monitoring of a patient, the efficiencies begin to multiply.
The other flavour of funding model leading to accelerated RPM deployment and integration across the care continuum is Outcome-Based Reimbursement (OBR). OBR will often combine home care with acute care and aim to reimburse the end result rather than each service delivered. This works well with episodic interventions like a hip or knee replacement.
For RPM interventions related to ongoing chronic disease management, the focus shifts away from curing the problem and toward such outcomes as reduced hospital readmissions. Whatever the condition, whether fixable in the near-term or manageable over the long-term, funders are increasingly focused on finding ways to encourage virtual care and pay for it as part of a holistic package of care and not as a silo separate from hands-on care.
As these trends sweep through the industry in 2019, we at AlayaCare are focused on enabling every agency’s staff to deliver great care by implementing exceptional technology that moves the business forward.
What trends are you seeing in your own region?