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HEALTH CARE AT HOME: Critical Success Factors for Staying in Demand


Business success in home care and hospice is about evolving in ways that will improve finances and continue to create positive changes for patients, and the groundwork for a successful future will require nothing short of total transformation.  Robert J. Simione, Managing Principal at Simione Healthcare Consultants, maintains that the rising waves of regulation and accountable care initiatives present a golden opportunity to grow health care at home if organizations are willing to collaborate in the formative stages to build a more organized system of care. Simione delivered the keynote address, “Critical Success Factors for Home Care & Hospice”, in April at the Executive Summit of the 42nd Annual Conference of the Association for Home & Hospice Care of North Carolina in Raleigh-Durham. 

“The time to get involved in collaborative strategic initiatives is now, and home care and hospice providers need to do this urgently,” says the 35-year finance and operations veteran in home care and hospice. “Providers, physicians and administrative leaders in nearly every U.S. market are gathering to develop partnerships and programs around a shared commitment to quality, cost and improving the patient experience across the care continuum.”     

According to Simione, home care and hospice providers need to consider strategic initiatives in four key areas to align themselves with the new realities brought about by government, public and private healthcare developments.  First, providers need to look from within to adopt best practices for quality improvement and cost reduction, while comparing performance against industry benchmarks and maintaining a strong compliance and risk plan.  “Home care and hospice providers with strong operating results will be best positioned to demonstrate value to hospitals, payers and other potential collaborators.  They need to show that they can control costs and improve quality, solving for problems such as preventable hospital re-admissions or other areas of concern,” Simione says. 

With internal operations maximized, the second area of focus involves market alignment to ensure a home care or hospice organization’s viability within a system of care, working with hospitals, physician groups, and payers, or merging with another organization to maximize resources and improve finances.  “The selection of new business partners and arrangements brings a certain level of change and uncertainty. While new ways of doing business may mean that we must leave a part of what we did behind, they also bring opportunities to help home health and hospice emerge in a stronger position both clinically and financially,” Simione explains.

A third area for strategic initiatives rests in program development, where agencies should explore options to enhance patient safety and provider communication such as care transition programs, wellness clinics and telemedicine.  “Along with some cost benefits, all of these programs promote patient autonomy through prevention, education and support activities designed to keep people well at home and able to enjoy more active lifestyles,” says Simione.  Other program development opportunities exist in “population health management”, meaning that home care and hospice agencies should get involved in developing better service delivery models for specific patient groups.  Several examples of population health management include advanced primary care centers also known as “patient-centered medical homes”, and integrative care programs for chronically ill, medically complex patients.  “Among all health providers and settings, the basic goals with population health management are the same – to improve quality and reduce cost – while enhancing the underlying information management systems that support care,” Simione adds.

The fourth component for success through strategic initiatives involvesdiversification, meaning the way an agency chooses and structures its business in home health, palliative care, hospice and/or private duty services, according to Simione.  “By diversifying their ‘out-of-hospital’ services, agencies can offer the full complement of care options to their referral sources, thereby fortifying census and expanding revenue streams. Hospitals want relationships with agencies that offer the convenience of a single point of contact able to solve for a variety of patient needs,” he says.

The Affordable Care Act is also driving quality improvement, challenging all providers to create and demonstrate value in managing the healthcare needs of populations. An agency’s strategic plan should follow suit, starting with a self-assessment that identifies: 

  • Current/future issues on the federal/state level, and their impact on agency finance and operations

  • Position in the marketplace (competition, referral sources and market share)

  • A business plan to determine short-term vs. long-term objectives, acquire the capital required to meet those objectives, and calculate return on investment 

“An agency’s self-assessment should involve staff at all levels in addition to the Board of Directors or investors to ensure that all factors regarding quality, finances and operations are evaluated.  These activities will typically require agencies to make hard decisions, so a thorough and open-minded review of current and future status is necessary to stay focused keep moving forward successfully. Once you have the right processes and right people in the right roles, you have the key ingredients to build momentum,” Simione says. “Above all, you must be able to demonstrate the value that you bring to the table, and be willing to enter into risk-sharing arrangements with strong quality measures and outcomes, and full knowledge of your costs.”