An important challenge in medical care is to provide the correct type of care at the right time and for the correct duration. That is especially true for the posterior care after a hospitalization when the lack of adequate monitoring care and inappropriate support put patients with high risk of hospital complications and re -entering.
Among the factors that affect the recovery of a patient is the environment in which it is provided. Although the qualified nursing and rehabilitation facilities were common options for recovery, home care has also become an integral part of the spectrum after patient care, as an appropriate option for Medicare members.
At the same time, suppliers face a series of challenges to provide access to home services that meet the needs of their patient population. The key among them are the shortage of qualified doctors, who have left many health agencies at home with little personal and unable to assume increasing references. This is particularly true in certain areas of the country where there are important imbalances between the substantial and growing population of the region and the number of doctors available to serve them. The problem is added payment models that can discourage suppliers to assume patients who need more precision at home.
However, health plans are using technology to better predict the future medical care needs of its member population. They can then design models based on the value that allow suppliers to innovate the flexibility to help ensure that supplier networks are more prepared and equipped to meet patient demand.
Predict the needs and results to help improve the quality of home health
The first step to improve the quality of home after the acute is to understand the tendencies of the population and health of the home to predict future health service needs. Automatic learning models reported by large amounts of claims data that contain a wide range of clinical and demographic details can help better predict home health results. Deepen specific geographies, age groups and health conditions, as well as the quality of care of the individual provider, among many other factors, allows payers optimize their supplier networks and design the correct payment models and incentives that address the needs of its members.
Analyzing these trends and services associated with positive results can also help direct the appropriate services and duration of patients who would benefit most from them, which is especially critical when the ability of the health provider in the home is limited. Providing the correct level of care for the level of particular acuity of a patient helps maximize access to subsequent services to acute for the entire population of patients.
Enable innovation through value based on value
Value -based attention encourages the reinvention of care approaches. That may include the use of virtual visits, monitoring technologies and AI systems that reduce administrative load and increase efficiencies so that doctors can spend more time taking care of patients. Innovation can also take the way of being more prescriptive about the type and regularity of the care that a patient needs. Determining the correct combination of care, which may include visits in person and telesalud, along with remote monitoring, can free doctors to serve more patients, particularly necessary in rural and unattended areas of the country. The reimbursement structure in value -based care models is designed to reward suppliers based on the best results of patients that reduce the total cost of care, offering them this flexibility to innovate.
Align attention models with the needs of the population
Value -based attention arrangements also align incentives for both payers and suppliers with the diverse needs after the population of their member. For example, a health plan can see that a segment of the member population in a particular state has a high acute condition rate that often results in hospital re -entry. Payment structures can be redesigned to align reimbursement rates to help improve results within a specific population segment. Doing so can increase the number and quality of suppliers in the network of a health plan that is aligned with improving that condition, which in turn will help improve access and reduce hospital re -entry rates.
Value -based attention is not a unique proposal for everyone. Payers can implement a wide range of value -based arrangements, from quality incentives to totally captured models, depending on what best meets the population’s care needs.
The use of predictive analysis and a diversified approach to provide value based on value helps to ensure that payers and suppliers can meet the needs subsequent to the acute of their Medicare members. The precision prognosis of the required clinical care and the results of those who receive services in the home, as well as to allow innovation with value -based arrangements, can help overcome barriers to high quality home care after patients who need these services.
Cassie Houff is a vice president of care solutions after the acute in A houseAn organization based in Miramar, Florida, dedicated to optimizing the management of attention in attention after the acute.
