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Next Generation Home
Health Strategies
Keith Crawford, SVP
Overview
Keith H Crawford, Coram, Senior Vice President, Strategic Initiatives
Session Description:
Home Health has quickly grown into an integral part of our long-term strategy to
reduce the costs of healthcare while improving quality of care. In order to develop
and implement a successful Home Health strategy, organizations much focus on a
number of factors including patient ownership of their health, technology,
communication and collaboration. During this session, attendees will learn some of
the ways that Home Health is changing a care providers business model and how to
build the correct Home Health strategy for your organization.
Learning Objectives:
 Discuss how to work with various third party organizations and technology
providers to develop a successful Home Health strategy for your
organization
 Develop a deeper understanding of the role secure information sharing and
interoperability plays in Home Health
Keith Crawford, SVP Coram Specialty Infusion
Healthcare Delivery
Whether referred to as integrated healthcare or accountable care, the current focus on
new healthcare models is a reaction to long-standing concerns around quality, cost,
and efficiency.
Many of these issues stem from care delivery systems that have been:
 Directed more at acute, episodic treatment rather than prevention and early
intervention
 Fragmented rather than integrated and coordinated
 Focused on patient eligibility and billing rather than patient engagement within
and outside of the care setting
 Customized to the idiosyncrasies of individual facilities rather than
standardized across care sites
 Rewarded more for volume than for quality and cost outcomes
The resulting inefficiencies have made healthcare less effective, less
safe, and more costly than can be tolerated…
Keith Crawford, SVP Coram Specialty Infusion
New Care Models
New care models represent an effort to solve deeply embedded healthcare delivery
problems experienced by organizations of all sizes. Part of the solution is better quality
and cost measurement and broader knowledge sharing…
Underneath their often complex regulations, Accountable Care Organizations (ACOs)
and Integrated Healthcare Organizations (IHOs) share a similar backbone – the drive
to address population health management.
Population Health
Population health management can be understood as the practice of engaging a
clearly defined group of patients and providers across the care continuum. The goal is
simply to enable better health outcomes for all at the lowest cost.
The pillars of population health are summed up in the Triple Aim of the Institute
for Healthcare Improvement:
 Provide better health outcomes for the population served
 Enhance each individual’s experience of care
 Reduce the per capita cost of care
Keith Crawford, SVP Coram Specialty Infusion
Population Health
The intent of population health management is to replace fragmented, episodic care
delivery with a holistic, coordinated approach that improves the health outcomes and
experience of care for the population served, while lowering per capita costs.
To be capable of providing true value for population health management - an
healthcare information technology platform requires three foundational “layers”:
 Data Collection
Electronic repositories that record patient care from two perspectives–clinical
(Electronic Medical Records) and administrative (revenue cycle, claims)
 System Intelligence
Rules-based workflow that enables the leveraging of clinical and operational
guidelines and policies throughout the care process – predictive modeling
 Data Interoperability
Standards-based Health Information Exchange (HIE) technology that enables
data, workflow and applications to be uniformly accessible across the
community of care
Keith Crawford, SVP Coram Specialty Infusion
Epidemiologic Impact / Age Wave
One of the most important social phenomena which the U.S. will experience is
the coming “Age Wave” which will impact virtually every aspect our society
and dramatically impact our healthcare system
In 2011 – The first of the baby boomers turn 65
• 10,000 Americans celebrate a 65th birthday daily
• 80% have three or more chronic conditions (Co-Morbidities)
• Highest per capita annual healthcare spend (~$15,000)
Adults 65 years and older account for:
•
•
•
•
30% of all doctor’s office visits
58% of all in-hospital days of care
70% of all <30 days hospital readmission
80% of home care visits
The Senior Boom
•
•
•
•
79 million Baby Boomers in the U.S.
Boomers are between the ages of 47 and 65
By 2030, 26% of the population will be 65 or older
60% use social networking, 55% have smart phones
Keith Crawford, SVP Coram Specialty Infusion
10,000
Americans
turn 65
Every
24 Hrs
Boomer generation controls
77% of all U.S. financial assets
They control 55% of
discretionary spending
Healthcare Information Technology
The limitations of paper-based care documentation have been well-established.
Such systems slow the dissemination of vital information, introduce greater likelihood of
error, and add cost and inefficiency to patient care.
An EMR, in contrast, creates a dynamic electronic record of patient encounters
over time, iteratively adding data on patient demographics and problems, clinician
notes, treatment recommendations, medications, vital signs, and other information.
According to the U.S. Department of Health and Human Services, “Increased
adoption of EMRs has the power to cut health care costs, reduce paperwork,
improve outcomes, and give patients more control over their health care, while
maintaining full protections on the privacy of individual health information.”
Industry-wide, total savings could range
up to $100 billion over the next 10
RAND Corporation
$12 billion in Medicare and Medicaid
costs over the next 5 years
RAND Corporation
Keith Crawford, SVP Coram Specialty Infusion
EHR will result in total cost savings
of $200 per patient per year.
MASTEK Corporation
Poor Drug adherence and medical errors,
cost reduction could of $50 billion a year
MASTEK Corporation
Fragmented Healthcare
Disparate Electronic Medical Records
Currently the hospital acts as
the “centroid of care” with
providers organizing care
activities around that setting.
The use of EMR is customized
to the idiosyncrasies of
individual facilities rather than
standardized across care
settings - leading to
transactional care and elusive
longitudinal medical records.
The consequences of fragment
care and disparate EMRs puts
the patient at risk and
removes them from
proactively managing
their health.
Patient
Centroid of Care
Specialist
Pharmacy
EMR
EMR
Emergency
Hospital
EMR
EMR
Doctor
Keith Crawford, SVP Coram Specialty Infusion
Allied Health
EMR
EMR
Homecare
EMR
Transforming The Healthcare Continuum
Complete exchange of health-related information that meets interoperability standards and
can be created, managed, and consulted by authorized clinicians, staff, and patient across
more than one health care organization – the patient becomes the “Centroid of Care”
Prevention
Pre-Acute & Acute
Chronic Care
Centroid
of Care
Doctor
Allied Health
Emergency
Pharmacy
Hospital
Specialist
Health Information Exchange
Patient
Homecare
Homecare
Supportive Care
Disease Management
Remote Monitoring
Care Coordination
Post-acute Care
Pharmacy
Care Coordination
Disease Management
Pharmacy
Prevention
Pre-Acute & Acute
Chronic Care
Keith Crawford, SVP Coram Specialty Infusion
Homecare Strategies Discussion
Emerging care delivery model – the home becomes the central cost pivot
Chronic-Care
Preventative Care
Acute-Care
Emergency
Hospital
Doctor’s Office
Home
Pharmacy
Dentistry &
Vision
Learning Objectives:
 Discuss how to work with various third party organizations and technology
providers to develop a successful Home Health strategy for your
organization
 Develop a deeper understanding of the role secure information sharing and
interoperability plays in Home Health
CMS Pricing Data, MedPac Pricing Analysis, Internal Coram Data, KHC 2012
Next Generation Home
Health Strategies
Keith Crawford, SVP