Supporting the shift toward value-based health care

The United States spends roughly $3.6 trillion on health care each year, equivalent to nearly 18 percent of the gross domestic product. However, the United States does no better in population health outcomes compared to other high-income countries that spend half as much money on health care. Thus, in recent years there has been a shift toward value-based health care, in which health care providers are paid based on the management and health outcomes of their patients, rather than the number of patients they see. Value-based health care could help stimulate better quality care for patients, saving individuals and the government more money in the long run.

One such area of value-based health care is home health care, which is often initiated after a hospitalization and provides a way for patients to receive continued care within the comfort of their homes. The goal of home health care is to help homebound patients recover post-discharge and ultimately avoid unnecessary readmissions to the hospital, saving the patient and hospital time and money. However, even while transitioning to value-based care, home health agencies are still rewarded for seeing more patients per day rather than for the value of their services.

With the health care industry shifting to value based care, it is important to understand how the delivery of care in the home could be better designed to improve the quality of care for patients and reduce inefficiencies, such as hospital readmissions.

Elena Andreyeva, PhD, assistant professor at the Texas A&M University School of Public Health, recently explored whether and how the amount of time that a provider spends during a home health visit with a recently discharged patient impacts the likelihood of hospital readmission. The study, published in the journal Management Science, used a rich data set to characterize patients and their home health visits, and determine the average amount of time health care providers spend with their patient (nearly 44 minutes). The data on time spent with patients was adjusted for patient demographics and condition-related characteristics, such as if the patient was sicker than average.

The study suggests that on average, an extra minute during a home health visit is associated with a 1.39 percent decrease in the likelihood of readmission to the hospital following that visit. To put this finding into perspective, if health care providers spend about an extra five minutes with their patient during a home health visit (an increase from 44 to 49 minutes), they could decrease the likelihood of their patient being readmitted to the hospital by 6 percent. These findings are significant, especially for Medicare patients who have a hospital readmission rate of about 20 percent, Andreyeva said.

“I think these results confirmed our hypothesis that if you spend more time with a patient during a home health visit, you might uncover potential health issues before the patient’s health gets worse and requires a hospital readmission,” Andreyeva explained. “Given that home health agency services are typically a lot less expensive than hospital stays, it makes sense to invest more into home health infrastructure, such as hiring more personnel, if that helps patients remain healthier.”

Further, a cost–benefit analysis that used the study’s findings, general trends in home health costs, and the cost of hospital readmissions, suggested that investing in home health services would save money due to projected fewer hospitalizations.

The results of the study and cost-benefit analysis support the shift toward value-based health care. However, there is still more to explore.

“One limitation of our study is that we do not know what went on during these longer home health visits that led to a decrease in the likelihood of hospital readmission,” Andreyeva said. “Did the nurse talk longer with the patient and uncover a potential issue? Or was the visit longer because the nurse had important health care steps to take with the patient? It is extremely important to understand which aspects of a home health visit are the most important in preventing hospital readmission. This way, we could tell home health agencies not just that the visits might need to be longer, but what a provider should do to limit the risk of hospital readmission.”

– by Callie Rainosek