The COVID-19 virus ought to spur a brand new world fee system that unlocks the capabilities of home-based look after a wider vary of sufferers, Humana (NYSE: HUM) executives argued in a brand new op-ed revealed Thursday.
That fee system would encourage a larger use of home-based care providers, permit extra sufferers to be eligible for them and improve innovation within the area, Humana CMO Dr. William Shrank and Susan Diamond, Humana’s home based business president, acknowledged within the op-ed, revealed within the Journal of the American Medical Affiliation (JAMA).
Louisville, Kentucky-based Humana — one of many largest Medicare Benefit (MA) gamers within the U.S. — operates Humana At Dwelling and Kindred at Dwelling.
Kevin Volpp, a professor of drugs and medical ethics on the College of Pennsylvania, was additionally a co-author of the piece.
“In health care, there has been a shift toward provision of home services, with substantial growth in areas such as provision of home infusion therapy and remote monitoring of blood glucose levels,” the authors wrote.
COVID-19 has accelerated that shift.
Amongst its suggestions for enhancing the home-based care ecosystem, the joint article means that the latest Facilities for Medicare & Medicaid Providers (CMS) waivers that present extra “homebound” standing flexibilities ought to proceed to increase and turn out to be everlasting.
“[CMS] provided a waiver for homebound status in the setting of the COVID-19 pandemic, which, when combined with regulatory relaxation and the recent rapid adoption of telehealth, will allow for more rapid development of new clinical models at home,” the authors mentioned.
Proper now, the concern is that the present restrictions stymie at-home innovation.
“The payment system should encourage clinicians to recommend whatever service will produce the most health benefit for a given price without distortions, such as payment being offered only for visits in a medical facility,” Shrank, Diamond and Volpp maintained.
The best model for home-based care would encourage well being techniques and well being plans to work collectively in an effort to advance residence care by know-how and a consideration of social wants.
The aim, in keeping with the authors, is to attain a system that’s extra wise for all, first contemplating the affected person.
“The payment model would incentivize clinicians and health care organizations to deliver services most likely to benefit the patient considering the cost and alternative uses of that resource,” they wrote. “If a health system is only paid when a clinician sees patients in the office, the clinician is unlikely to enroll the patient in unreimbursed home-based services.”
Moreover, the proposed model would emphasize delivering care providers the place they’re finest match to be delivered.
“The proposed model would meet patients where they are,” the authors acknowledged. “Whether clinicians are formally in a risk-sharing arrangement or not, system designers should view provision of care in the site that will be most efficient in improving health in developing care delivery innovations. Insurers only paying for in-person visits as a way of verifying that care was actually provided should become a thing of the past.”
Moreover, the model would encourage clinicians and well being care organizations to take note of analytics that may prioritize a long-term view over short-term cost-saving measures. Preventative and remedy providers would even be valued equally.
“Analytics should be used to systematically identify patients who are at elevated future risk to guide interventions that proactively lower risk,” the authors wrote. “For instance, cancer treatment should consider the cost relative to the benefit, and smoking cessation program attendance should be encouraged even if it does not save money in the short term.”
Making a fee model that can encourage innovation within the residence is an important step for payers to unlock all the advantages of home-based care.
Adopting new scientific fashions in COVID-19 is critical, however long-term sustainability must also be thought of.
“It is time to move beyond the limited definitions of home care currently used by Medicare and create payment models that support innovation of care provided in home-based settings,” the authors mentioned.