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Discharge Planning in A Value-Based World: How Can You Provide Value and Still Honor Choice?

  • Nov 15, 2018
  • Meaghan Puglisi
  • 5-min Read

It isn’t enough to just hand a few brochures to seniors or give them a list of home care providers to choose from if we aren’t first asking them: what are your goals after you leave here? Here being the transitional care unit, hospital, physician office, or emergency room. As the discharge planner or social worker, you always want to honor a client’s choice, we too believe firmly in honoring choice, but clients don’t always know what services they need or how to choose the right home care provider. But they know what they want – their goals, their experience – for themselves. See the difference?

As value-based care models continue to prove their worth, we have to remember to put the client first.  It’s the only way these models of care will work. But in a fast-paced environment and systems riddled with regulation, how can you provide value and still honor choice as a client returns home? In other words, how do you provide a framework so they can make the best decision that works for their individual goals?  How do you help them evaluate the value of specific home care providers and how those providers help them achieve those goals and improved outcomes? The IMPACT Act puts the onus on care coordinators to educate, advocate, and use data to help clients make informed choice.

In a value-based world, health care organizations are creating narrower lists of providers with whom to coordinate care based on improved outcomes and that is exciting news as we begin to build the right framework to support clients’ goals long-term.

Clients may have a preference for a specific provider based on a neighbor’s experience or even their own past health issues. But is that the right choice for their current situation?

Clients want your guidance. A study done by Home Care Pulse shows clients value your input as healthcare professionals and look to a providers’ reputation or recommendation from a referral source as 2 of the top 3 reasons they choose one provider over another. You can’t choose for them but you can understand what they want out of their choices and help them choose options that meet their goals.  And educate them so they become knowledgeable and engaged consumers.

  • What are their goals? Do they need someone to help clean their home or get their holiday shopping done in time (these things can stress out clients who enjoy doing this but can’t after a health crisis), assistance identifying an expert in Lymphedema, options that bridge Medicare home health with private-pay without needing to call multiple organizations as needs change, or help asking the right questions at their follow-up appointments? Knowing the answers to these can help narrow down options. Download our ‘In Home Provider Checklist’ to share with clients as a guide.
  • Are home care providers showing you their data? While Medicare Home Health providers may be sharing data, few private-pay ones have any data to show – and yet they should. In a value-based world, you need to educate clients about which private-pay providers are effectively reducing hospitalization or ER visits, and share that measurable data. Those providers demonstrate a greater ability to keep clients home without readmission and prevent future health crisis – and that saves clients money as well as their independence.
  • Is recovering at home important? Share with them why investing in home health can help them recover at home safely and at a lower cost than rehabilitation hospitals or even skilled nursing facilities.
  • Are the home care providers holistic a.k.a., whole person? Are they incorporating prevention, wellness, and life goals into the plan not just medical- or diagnosis-focused on the reason for discharging home? Increasingly providers are addressing the social determinants that can affect a person’s wellbeing beyond they health issues they face.
  • Average hourly costs are often the deciding factor when it comes to choosing a home care provider but that is a narrow perspective and can be very misleading. To keep costs low, people often choose the lower cost options up front but they should look at total cost over the month or longer. There’s a need to educate clients so they develop a deeper understanding of what cost means long-term to create sustainable value, better outcomes in the long run, and help seniors avoid mistakes caused by choosing the cheaper provider up front. The focus should be on reducing the amount of care overtime, avoiding readmissions, and maintaining healthy, independent lives but that can’t happen by choosing options based on hourly cost alone – the larger hourly cost may be a better option.

The influence we provide through education about how to choose in relation to clients’ goals creates long-term value. This mindset shift also puts the pressure on home care and home health providers to show their own value and prove it. It’s not enough to just say we deliver value-based care; we have to prove why our particular models, programs, companies, are supporting client goals long-term and improve their experience.  So you can feel good about the options you share with clients.

We want to know, how are you influencing value while honoring choice? What frustrates you most about helping people make informed decisions on post-acute choices? Share On!

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