Managing Complex Conditions in Home Health: Strategies for Improved Care Coordination, Reimbursement, and Outcomes

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Managing Complex Conditions in Home Health

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Managing Complex Conditions in Home Health: Strategies for Improved Care Coordination, Reimbursement, and Outcomes

Kathleen Heery, RN, MS, CCM, CCP 

Home health patients with chronic, complex conditions present care coordination challenges that are hard to overcome without proper understanding and training. Poor coordination and planning for these patients can result in poor patient outcomes, rehospitalizations, poor star ratings, and lower reimbursement. Managing Complex Conditions in Home Health is a complete manual through which staff can prevent declines and adverse events through sound patient planning, while ensuring reimbursement and positive outcomes for their home health agency. This manual discusses multiple payer and reimbursement solutions, frontline clinical care techniques for chronic disease management, care coordination strategies, and patient engagement for lifestyle and behavioral changes.

This book will help your home health agency: 

  • Cut down on hospital readmissions 
  • Maximize reimbursement 
  • Avoid adverse events 
  • Improve patient outcomes 


About the Author:

Kathleen Heery, RN, MS, CCM, CCP, is a small business owner and consultant providing community case management and homecare service support to elders, their families, and other providers. She is a certified case manager with more than 30 years of professional healthcare and eldercare experience. Heery is a founding partner of the Elder Life Care Network™ in Plymouth, Massachusetts, which is building a new model for eldercare by leveraging proven case management techniques and innovative technologies that connect and communicate with cross-continuum providers.


Published: September 2016

Page count: 180
Dimensions: 8.5x11
ISBN: 978-1-55645-845-3

Table of Contents

Introduction

For All That Has Changed, Not So Much Remains the Same
Personal Health Management
Transforming the Way Care Is Delivered
Changes and Challenges to the Home Health Benefit: Federal, State, and Agency Levels

Chapter 1: A Game Changer

Changing Healthcare Environments
Understanding How We Got Here
Trends in Healthcare Delivery
Managing Complex Chronic Care for Aging Populations
Expanding Models and Methods
A Look at Population Health Management
Across Organizational Boundaries: Opportunity and Teamwork: Top 20 Patient Situational Challenges
Emerging New Models Means New Roles

Chapter 2: Using the Same Playbook When Managing Complex, Chronic Illness

Examining Chronic Illnesses: Prevalence, Costs, and Risk Factors
Chronic Conditions in the Home
Chronic Obstructive Pulmonary Disease (COPD)
Heart Failure
Cardiovascular Disease
Dementia

Chapter 3: Lifestyle Changes for Patients

No Quick Fix
Recognizing the Main Forces of Chronic Illness
Combating the Forces of Chronic Illness
The Role of Diet in Managing Chronic Illness
Role of Weight, Exercise, and Activity
Physical Activity for Patients With Chronic Illness
Impact of Stress on Health
Planning With the Patient: For the Now and the Future

Chapter 4: From Telling to Coaching

Letting the Patient Take the Lead
Evaluating Readiness to Change Behavior
Health Coaching as a Healthcare Intervention
Employing Motivational Interviewing Techniques
Pulling It All Together

Chapter 5: Maximizing Team Performance Through Care Management Practices

Complex, Chronic Care Management
Overcoming Multiple Challenges of Chronic Care Management
The Six Domains of Community Case Management
Establishing Cross-Continuum Teams
The 12 Commandments of Community Case Management
Dealing With Challenging Situations
Dealing With the Avoidance of Death

Chapter 6: Reimbursement Challenges

The Health and Economic Costs of Poorly Managed Transitions
From Disease Management to Chronic Care Management
Financing Emerging Delivery Models
The Right Financial Prescription for Medicare
The Right Financial Prescriptions for Medicaid
Collaboration and Integration: Blending Payers
Collaboration and Integration: Blending Provider Services
Funding Technology in Home Health
A Look Into the Future

Appendix: Resource List

Financial
Legal
Medical/Personal Care
Transportation
Social and Support
Community Resources
Quality 

Tools, Tables, Charts, and References

Triple Aim
Acute Illnesses vs. Chronic Illnesses
Population Health Management and Health Risk
Heart Failure Classification
Weight Loss Medications
Arthritis Medications
Cardiovascular Disease Medications
COPD Medications
Dementia Medications
Diabetes Medications
Heart Failure Medications
Recommended Exercise for Adults
Medical and Non-Medical Approach
Maslow’s Hierarchy of Needs
Telling to Coaching
Complexity of Care Coming Home
Acute to Chronic Care Management
How Hospitalizations Present in the Home
Palliative Care vs. Hospice Care
Examples of Medicare Payment Innovation