I’m flying back from an ACO conference where for several days a lot of very smart people opined about the state of health care delivery in this country. I am also looking at, on my cramped 11-inch MacBook Air screen, a copy of what was to eventually be a commentary called “Rebranding Home Health.” The gist of the piece—one that will never be published—is this:

1. Home health agencies, home infusion companies and Private Duty (home care where nursing isn’t required) agencies have terrible consumer brand awareness. Our own study of more than 500 consumers shows just how bad it is: about half of consumers had a recent experience with home health, either for themselves, a spouse or a parent. Yet less than 5 percent could name the company that provided the care. Home health companies also have, relatively speaking, poor brand awareness among other health care executives We have another study that suggests this. 

2. Most home health agencies are also terrible marketers. They conflate relationship-based selling—getting to know discharge planners and high-use physicians, which they call marketing—with actual marketing, which includes positioning, messaging and an overall strategy to reach the people most likely to buy from you. Remarkably, while previously doing some industry research, I found websites from competing home health agencies using similar—even the same!—stock photography. No wonder awareness is low. It’s hard to tell them apart.

And this is the point in the essay where I began my rant about the need for home health agencies to think like marketers, to outsmart their competitors with savvy positioning and messaging, to effectively rebrand themselves.

I was wrong. Home health care doesn’t need rebranding. Home health care needs reinventing.

If you’re a home health provider and not part of a hospital or health system, your world looks something like this: You allow a hospital Discharge Planner (your customer) to choose which agency will care for the homebound patient (also your customer). You allow how you get paid to be dictated by CMS (your ultimate customer). You itemize every last thing you do and use coding techniques to maximize how much you get paid. You have a hard time finding people to work for you at a wage where you still make a few bucks.

To readers of THE OC REPORT, this must sound like a miserable business. And it is. Or rather, it has become one ever since CMS set its sights on value-based payments. Everything about the home health business is fee-for-service, which is a bad sign if CMS pays the bills.

Now, people prefer care at home to care in a nursing facility. Care is normally as good in the home as in the hospital, with few exceptions. Care is cheaper in the home. And it provides seniors with a feeling of hope—the opposite emotion associated with living in a nursing home. Home health care just makes sense. 

Yet CMS didn’t go out of its way to include home health in its immediate plans for health reform. Some believe that by continuing to cut back on the rates it pays home health care providers it’s signaling to the market it wants the mom and pop providers out of the business. While that may be true, I think that it’s CMS telling the industry: innovate or die. Figure out a way to change how you do business that fulfills The Triple Aim.

The home health provider of the future will resemble companies like Visiting Physicians Association, which employs primary care physicians and nurse practitioners that make house calls, provides lab services and in-home diagnostic testing, manages the pharmacy and coordinates care throughout the system. They will align with ACOs, hospitals and health systems for bundled services and risk based contracts based on patient type. They will offer full-service coordination of post-acute care and will manage challenging populations with chronic, comorbid conditions. They’ll be fully responsible for the quality of care and will put their payment at risk if quality suffers. 

We know of several home health providers that are paving the way and are moving down this path. But they’re rare.

Note that Private Duty companies don’t have these problems because Medicare doesn’t pay for their services. That doesn’t mean that there isn’t an opportunity here for home care companies to be part of the solution as well.

At the ACO conference this week the first keynote was Patrick Conway, M.D., Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer. Early in his presentation he highlighted the aforementioned home health data from the Independence at Home project, in which the program evaluation shows more than $3,000 savings per patient per year for home-based care compared with controls. The audience roared, impressed by the achievement.

So was I.

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