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INTRODUCTION

Those who are immersed in home care in any capacity can get used to how things “are”—but home care, like all healthcare, undoubtedly will continue to shift and change. For instance, the Centers for Medicare & Medicaid Services (CMS) proposed a pre-claim review demonstration project. The states identified for the pre-claim review demonstration are (in order of participation): Illinois, Florida, Texas, Michigan, and Massachusetts.

In another change, the Home Health Consumer Assessment of Healthcare Providers and Systems (CAHPs), a program from the U.S. Agency for Healthcare Research and Quality (AHRQ), makes scores available, which can be accessed by the public on the website Home Health Compare: www.medicare.gov/homehealthcompare/.

By 2018, the goal is to have all Medicare providers in alternative payment models. This means value-based care. One example of a bundled model that goes across all involved care settings and providers is the program that is in place for mandatory hip and knee replacement in certain markets. Of interest to home care is that the bundle does not just include the hospital-related care but also all additional care during the 90 days after hospital discharge.

Think about accountable care organizations, bundled payments, and other models that are value-based. The Home Health Value-Based Purchasing (HHVBP) model includes all Medicare-certified agencies in the nine states of Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington (CMS, n.d.-a). This model began in 2016 and runs through the end of calendar year 2022 (CMS, n.d.-a).

The good news, in this time of complexity and change, is that population health provides the vision of common goals across all healthcare settings. Post-acute care (PAC), of which home care is a part, “has been of increased interest to policymakers as a result of a 2013 Institute of Medicine (IOM—now called The Health and Medicine Division—HMD) report that identified the sector as the source of 73 percent of the variation in Medicare spending” (American Hospital Association, 2015, p.1).

Those already working in home care have the expertise to offer to others who are seeking partners and who need to better understand home care. This is especially true as care becomes more similar across care settings, including the development of cross-setting measures, and as the harmonization of healthcare continues. Nowhere is this more apparent than in the CARE Tool, which is the acronym for the Continuity Assessment Record and Evaluation (CARE) Item Set.

“The CARE Item Set measures the health and functional status of Medicare beneficiaries at acute discharge, and measures changes in severity and other outcomes for Medicare post-acute care patients. The CARE Item Set is designed to standardize assessment of patients’ medical, functional, cognitive, and social support status across acute and post-acute settings, including long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). The goal was to standardize the items ...

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