HME Business Article "Outcomes and Value-Based Care for the Respiratory HME"

June 21, 2022 | by Zach Gantt, RRT, FAARC




Patient outcomes are rapidly emerging as a powerful growth strategy. In fact, with large referrals and payers it’s becoming a requirement. Collecting patient-focused measures and transforming that data into clinical metrics is the key to success in the respiratory HME model going forward. Elite HMEs combine compliance information with respiratory outcomes, often using software to become strategic partners for referrals.


U.S. healthcare delivery is rapidly changing with emerging managed care initiatives, accountable care organizations, and other value-based care models. Hospitals want to be complete systems to maintain every penny of the healthcare dollar; physician groups can drive quality and revenue with aligned home providers; and payors are struggling to learn how to manage homecare patients, especially the 12 percent that drive 60 percent of the spending.


The intersection of these trends for chronic respiratory disease patients is in the home. Implementing outcome-based programs transforms the HME from being seen as an equipment supplier to a home-based pulmonary service partner. Managing patients — not just devices — creates opportunities. The question is, how do you “own the home” before your competition beats you?


Respiratory management software is the new model the industry is moving toward, especially for patients on advanced therapies like ventilation. The key to a successful transition to these models is adding sophisticated clinical metrics on top of device compliance results. These clinical metrics measure goal performance, objective data, and sometimes most importantly, subjective data like self-management skills or symptom management.


These goals and metrics need to be translated into patient language and need to communicate progress in an overall plan of care. For respiratory therapists, asking “how do you feel” questions at the point of care isn’t enough. They must collect scaled answers via software to standardize them and to understand the changes from initial visits to ongoing visits. Software also enables patient answers to be tied to actions and instructions and to prompt physician interventions. Additionally, a database can be used to analyze results and identify hidden relationships that drive better outcomes.


HOME OXYGEN PATIENT OUTCOMES

HME providers have an existing population of oxygen and nebulizer patients who will eventually need advanced therapies like Non-Invasive Ventilation and Airway Clearance devices. Due to reimbursement cuts over the years, these O2 and Neb patients are just provided with equipment and never clinically managed.


Creating a model to clinically manage these patients is key to identifying when these patients need other services the HME offers. HME providers can build these models themselves, or there are now services that combine the support of a Respiratory Navigator-staffed call center that assess patients and integrates the sophisticated outcome-based algorithms to manage the disease progression. The data algorithms from these brief and continual clinical calls measure patient engagement, identify gaps in care for physician follow-up, and detect increased clinical impairments that lead to advanced therapies such as non-invasive ventilation and high-frequency chest wall oscillation.


THE CHALLENGE

The challenge with moving into these models is RT staffing and clinical leadership shortages, and the biggest challenge is the need for a strategic shift in the business model. This creates the question of how do you get started moving into an outcome-focused model? First, you must decide to build it internally or outsource it to a turn-key partner with expertise in value-based care. More and more HME providers are making the decision to partner with experts in care coordination and population health to stand up a sustainable model without having to recreate the wheel.

Whether an HME decides to build it internally or outsource a clinical outcomes model the need to standardize clinical management, risk, and data still exists to play in the value-based world. This presents an opportunity to create unique strategic partnerships with Physicians, Hospitals, and Payers.

POINTS TO REMEMBER

  • Patient outcomes are emerging as a powerful growth strategy for Respiratory HME Providers.

  • Tracking outcomes means thinking outside the box and managing “beyond the box” or managing beyond the device.

  • Outsourcing clinical management models to organizations already engaged in population health models will accelerate the strategy.

  • Value-based care is about reducing utilization and improving outcomes; both can be achieved by matching the right patient to the right therapy at the right time.


Link to HME Business Article