I've written previously about the increasingly prominent role home health care is playing in shaping how health care is delivered to all Americans--especially in helping our nation's seniors age safely in place in their homes and communities. This movement is being led by one of our industry's primary trade organizations, the Visiting Nurse Associations of America, or VNAA. The VNAA represents the majority of health care and hospice providers in the U.S., including over 900 certified home health agencies (CHHAs), ranging from small stand-alone agencies to very large agencies like the one I work for, Visiting Nurse Service of New York (VNSNY). Their membership also includes more than 42 healthcare systems across the nation--an important fact, since collaboration among the full range of care providers is a key element in today's care delivery models.
"Our mission at VNAA is to transform home-based care," notes Tracey Moorhead, President and CEO of VNAA. "By that, we mean the full care continuum--not just post-acute care after someone is discharged from the hospital, but also wellness and preventative services, management of chronic or complex medical conditions, and palliative care and end-of-life care."
Enhancing Delivery of Services Across the Home Care Continuum
As a member of VNAA's Board of Directors, I have a firsthand view of the various ways that the organization is advancing home health care. These initiatives are focused on four key areas:
1) Improving patient outcomes by ensuring that home health and home-based care are integrated into various care delivery models. VNAA collaborates on a national level with a variety of health care industry and professional organizations representing health care systems; accountable care organizations (ACOs, groups of doctors, hospitals, and other health care providers who come together voluntarily to provided coordinated high quality care to their Medicare patients while working to hold down costs); patient-centered medical homes (primary care systems that stress care coordination and close communication, again with the goal of improving quality and patient experience while lowering costs); and physician group practices in the community. These national organizations provide guidance and resources to their own members on new care delivery and payment models. VNAA works with these partners to identify and disseminate models that effectively incorporate home health care services.
"Ensuring that these organizations incorporate home care into their models is critical," says Tracey. "Many health care provider models are trying to reinvent home care services on their own. We help them take a step back and realize that the solutions they're looking for have already been developed by our member agencies, and are being implemented in their communities by providers who often have long experience with the patient population in those communities." By partnering with existing home care agencies in their area, these health systems can ensure that high quality home care is integrated into their care delivery model, while avoiding the cost and administrative burden of devising and managing this home care piece themselves.
2) Ensuring home care quality and value nationwide by establishing and disseminating best practices for the industry. To help achieve this, the VNAA has created the "VNAA Blueprint for Excellence" that is available online at vnaablueprint.org. Visitors have free access to the four main Blueprint modules: Care Initiation, Clinical Conditions and Symptoms, Patient and Caregiver Engagement, and Patient Safety. (A fifth module on strategies for improving Star Ratings--our industry's official metrics for patient satisfaction--is available only to VNAA members.)
"This evidence-based guide to best practices in home care and hospice is the first resource of its kind," notes Tracey. "We're offering it free because we want to ensure that all stakeholders, including health insurance plans, have access to it." The Blueprint is updated several times a year, as new components and best practices are developed.
3) Spearheading innovation and transformation efforts. "As health care continues to shift from fee for service to value-based payment models, we're very focused on helping the home care industry transform financially," says Tracey. "We're finding that many of our members aren't prepared to work with insurers or other health care providers to implement these new value-based models, because they don't have the necessary financial acumen or experience in complex new payment models." To assist members, VNAA has developed a range of tools and resources, including online webinars, conferences where member organizations can get advice and guidance in person, readiness assessment tools, and strategic planning guidance through its website (vnaa.org) and onsite strategic support from VNAA representatives.
4) Working on a policy level to ensure the home care industry's success. VNAA's efforts in this area include meeting with various stakeholders to highlight the value of home based care and address concerns or misperceptions around it; establishing a code of ethics for VNAA members; conveying the industry's perspective on important regulatory issues, such as the current proposal by the Centers for Medicare and Medicaid Service to require prior authorization for home care services--a step our industry believes will interfere with timely implementation of essential services shown to prevent rehospitalization; and advocating policies that support a strong and thriving home care workforce.
Building a Home Care Workforce for the 21st Century
VNAA's workforce efforts include backing the expansion of formal training programs for home care clinicians. "The training aspect is extremely important," observes VNAA's Tracey Moorhead. "In particular, we support the Institute of Medicine (IOM) 'Future of Nursing' report's recommendations for promoting home care nursing as a career."
In 2014, VNAA teamed with researchers at George Washington University to publish an article in Home Health Care Management examining the scarcity of residency training programs for home health and hospice nurses and how the federal government could spur development of such programs. Since then, VNAA has continued to promote innovative home health nurse residency programs and generally encourage home nursing as a first career choice.
Strengthening the Industry's Voice in Washington, D.C.
To provide strategic support for these activities, VNAA collaborated with other home care leaders on the Future of Home Health Care project, which just published a number of key findings and recommendations, and also launched a new strategic planning initiative of its own in late 2015 that included the points outlined above. Most pressing of all is the industry's need for leadership and support in implementing new value-based payment models. "One roadblock that's keeping home care from being viewed as central to the success of value-based care delivery is the fragmentation of our industry at the national level," notes Tracey. In addition to VNAA, there are more than a dozen other national organizations that represent the home care industry in some fashion, and a large number of state-level organizations as well. "We want to collaborate with all of them," says Tracey. "But first we all need to be aligned."
The VNAA is optimistic that will happen, she adds, for a basic reason: "The goals of health care transformation can't be achieved without a robust and engaged home care delivery system."