How Value-Based Payments Improve Quality in Home Care

How Value-Based Payments Improve Quality in Home Care

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Mike Paladino: Alright welcome to CareSmartz360 on Air Podcast. I’m Mike Paladino, an account executive here at Caresmartz.

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Mike Paladino: value-based payments, shift the focus in home care from simply doing things to doing them well.

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Mike Paladino: Unlike traditional fee-for-service where caregivers get paid per visit value-based models, reward agencies for positive care outcomes.

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Mike Paladino: It can include things like fewer hospital readmissions, better pain, management, or increased care, recipient satisfaction.

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Mike Paladino: This financial incentive creates a system where quality care is good, business

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Mike Paladino: agencies invest in better training.

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Mike Paladino: communication

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Mike Paladino: and care coordination. To achieve these results.

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Mike Paladino: It encourages preventative measures to keep the elderly, healthy.

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Mike Paladino: reducing overall costs.

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Mike Paladino: Seniors benefit from a more holistic approach to their care, focused on their well-being and not just completing tasks. Thus value-based payments offer a promising approach to improve quality in home care.

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Mike Paladino: Today we have Fatih Sahar on the panel president of Extra glowbacks, a consulting firm that provides strategy, analytics and communication services to organizations specializing in healthcare.

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Mike Paladino: community-based and professional organizations, serving Medicare and Medicaid populations and also long-term care services and support

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Mike Paladino: welcome to the podcast Fady.

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Fady Sahhar: Hi! It’s good to be here.

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Mike Paladino: Yeah, we’re happy to have you on board and learn about the expertise you can share with regard to the value-based payment solution system.

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Mike Paladino: So with that, said Fadiya, do you have a list of questions for you? And I think it’s best if we just dive right in.

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Fady Sahhar: Go for it.

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Mike Paladino: The 1st question I wanted to ask you is, can you define quality in the context of value-based payments for home care?

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Fady Sahhar: So quality is defined by a variety of terms. Some of it can be

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Fady Sahhar: soft processes that organizations can implement, like having monitoring their caregivers to show up on time

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Fady Sahhar: to serve the full shift, to report at the end of a shift if a changing condition has occurred.

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Fady Sahhar: and while that may seem like a very simple everyday activity. The fact that an agency monitors that records it and takes action on it can be a very strong indicator of quality.

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Fady Sahhar: Other forms of quality, again, can be simple processes that the organization has in place in terms of when a supervising

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Fady Sahhar: The quality manager or nurse checks in the kind of the kind of reporting and measures that they have from their caregivers.

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Fady Sahhar: But we also find that quality in many terms as you get into value-based payments relates to managing the cost of care.

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Fady Sahhar: So we want to make sure that the agencies are taking actions that directly bring about a healthier consumer that we’re serving.

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Fady Sahhar: I’d like to believe that most of the people we serve are not sick. They just happen to be old or have a disability, so we don’t want to treat them as sick people, just like we do every day.

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Fady Sahhar: Individuals. We are people who are not receiving these services. We want to be able to help them avoid higher levels of care and their higher costs.

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Mike Paladino: Yeah. And I think that’s such an amazing point. You make it right? Because I think it’s also synonymous with quality of care increases. Yeah, know that value-based payment system, whereas people that are happier with the care they’re receiving are willing to pay a bit more for it in certain contexts right? Because I think you put it beautifully. You know, we are needing to treat people, you know, not as if they’re sick or they’re UN cape, or incapable right?

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Mike Paladino: Right? I think if you give them, you empower them with those quality services. The care outcomes are more likely to be positive, and the whole value based system is going to flourish right? Because everyone’s kind of reaping the benefits of exactly what your intentions are.

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Mike Paladino: So.

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Fady Sahhar: So people.

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Mike Paladino: Yeah, I think that’s a beautiful way to put it. And it’s certainly, you know, as we go through this, I think a a a lot of the commonalities we’re gonna see is really the quality, but also the communication that you can really instill amongst the care providers and the care recipients, and I think as long as everyone’s on the same page, from the top down from the agency to manage where they are and making sure they’re on premise and providing good care.

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Mike Paladino: You know the notes that are being taken about the recipient and also premium provided back to the agency is gonna help everybody from the quality perspective. To really ensure that we’re giving the best

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Mike Paladino: possible care to that individual. To ensure the outcome is a more positive one, or at least more likely to be a positive one.

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Fady Sahhar: Absolutely and just. It’s interesting as you’re talking one of the things that is important for a payer or a Mcco.

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Fady Sahhar: or, you know, if in a private pay environment even is that you need consistency, you need to make sure that as an agency you’re providing consistently quality services. It’s not good enough to make sure that on Friday, when the Supervisor is coming to check on you, that the house is impeccable, and

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Fady Sahhar: The consumer is well dressed. So it’s really valuable for us to know that

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Fady Sahhar: all of our caregivers are gonna perform in a similar manner. And no matter, when we check, we’re gonna find the same kind of results.

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Mike Paladino: Yeah, beautifully said. And I think that model is the one that I would want if I was getting care for my loved one. And funny enough we do have. An elderly grandfather is 95 years old, as you mentioned. He’s just elderly. It’s not like he’s not sick or anything like that. But he just needs assistance, and he needs someone to really just ensure his daily activities. Whether it’s cleaning the house, cleaning, the bathroom bathing, he could do all these things on his own.

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Mike Paladino: But having somebody to help is just ensuring that his end of life is more positive right, and we love the communication that the agency we provide, or that provides us with services gives us, and everyone’s happy with it. There’s no complaints. And on that same topic we’re willing to pay a premium because we know that our loved one is receiving excellent care right?

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Mike Paladino: Awesome. So the next question that’s a great segue is, how can caregivers be best equipped to deliver the quality care needed under a value based payment system.

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Fady Sahhar: I believe that what gets measured gets done

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Fady Sahhar: right? So if we train our caregivers

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Fady Sahhar: to report on and evaluate the work they’re doing themselves. They’re gonna do a better job at it.

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Mike Paladino: Hmm.

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Fady Sahhar: And so the number one factor in getting the results from value for value based payments is to make sure that your caregivers are appropriately trained for the people that they’re serving. And it comes sometimes in very interesting ways, you know, at the very basic level, you wanna make sure that the person is being treated with respect and dignity.

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Fady Sahhar: That, they’re not being forced to do things that they don’t want to be doing.

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Fady Sahhar: but

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Fady Sahhar: from a value based perspective. Now keep in mind that many of our healthcare providers, whether home care or home health providers have measures that come from a cap survey or from some kind of an Mcco selling them what is important to them. So, knowing what those measures are, and then training to them

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Fady Sahhar: is very important, and recognizing you know it.

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Fady Sahhar: I tell. I was recently talking with a group of

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Fady Sahhar: providers, and I said, You know we don’t hesitate to train our young people to be good batters when we want to teach them to be, or good pictures when we’re on the baseball field. Yet we just let a caregiver walk into the house, and sometimes just do what they think is best, we taking appropriate care to make sure that we? They know what’s a good way to. What’s the best way

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Fady Sahhar: to treat a consumer when they’re in their home is a first, and, you know, step to it, but also letting them know where the rewards of quality services are.

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Fady Sahhar: Sharing it with them. I find simple things like recognition by the caregivers on a frequent basis, peer recognition, as well as additional pay, is always a good way to incentivize these caregivers, but as an agency you have to be able to respond to the market where you work.

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Fady Sahhar: You can’t just say the same agency in New York and Miami are not gonna perform in the same way, because while they’re all reporting to some big Mcco somewhere. They may have different standards of expectation from what the Doh in New York wants versus

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Fady Sahhar: no Asian Florida. Once.

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Mike Paladino: Yeah, I think you. You’ve said it again beautifully. And I think it’s really just setting the standard of care. And the way that I’ve always perceived this. And I say this because my mom actually did run a marketing agency for about 30 years and always faces similar challenges with caregivers from a lot of different angles, right? Could be never missing, you know, never clocking in or clocking out on time, or documenting it, or missing notes, or that kind of thing or not showing up and disappearing right? There’s always gonna be, I think, inherent challenges, but I think

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Mike Paladino: The easiest way to solve that is setting the standard of care from the top down, and that comes with a few different things. Where it comes with training, it comes with providing them the right documentation and support to do their jobs as well. Very well.

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Mike Paladino: and it also comes from communication right, I think, as long as you openly communicate to them whether it’s recognition, whether it’s bonus pay or just, you know, giving them some sort of incentive to really care about the work that they’re doing and not look at it as just a job. I think those are the real important factors that really can ensure that the caregiver matches the quality that the agency is looking to convey.

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Fady Sahhar: And and to that point before you jump to the next question, is that

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Fady Sahhar: each of us sometimes, yeah. Will will interpret what is excellent work.

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Fady Sahhar: Sometimes as an agency, or you need to make clear that you explain to your carrier what is accessible for

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Fady Sahhar: and reward it accordingly.

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Mike Paladino: Yeah, I couldn’t agree more. And I think that’s again, it’s kind of going back to the top down approach where you have to lead by example. And I think it’s just setting that the gold standard of what care looks like, and the way that my mom kind of positioned it in her. She’s retired now, but in her day it was no. How would you want to be treated if you were in their position? Be empathetic, you know. Are you going the extra mile to make sure you did that thing for them? Are, you know, just kind of glossing over the tasks and just marking them down?

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Mike Paladino: Or did you really take the time to lift everything and dust it? Maybe they gotta, maybe their asthma has asthma, or maybe they have a sinus problem. They have difficulty breathing. They have Copd. You need to make sure things in their house are clean, right or dusted, so it doesn’t impede them. And those things is really what my mom focused on was, try to put yourself in their shoes, and would you be satisfied with the care that you gave

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Mike Paladino: to them if they were giving it to you. Right. And I think that’s always resonated with me. It’s almost like that golden rule. Right? Do unto others, as you know you would have them do to you not to go down that path. But I do think that there’s merit there that you know you want to treat people as you want to be treated to.

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Mike Paladino: Yeah, awesome. So that. That again, all these questions kind of do segue into one another. So the next one really focuses on challenges. So what potential challenges do you see? With a value based payment system in home care. And how do you address them?

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Fady Sahhar: So then, you know, I earlier talked about consistency, consistency comes from

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Fady Sahhar: being able to measure and monitor

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Fady Sahhar: and track and report and trend. So one of the things that that I think one of the major challenges an agency trying to enter a value based contract

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Fady Sahhar: is that they need to be able to validate that they are doing the things they say they’re doing.

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Fady Sahhar: And therefore they, you know, in my early days of value based payments, I used to say. When I get when I get talks, go out and buy an abacus

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Fady Sahhar: and learn to count, learn to count whatever it is that you want to count. You know. How many times did the people show up on time? How many people did they clock out on time? How many times did they get it? 9, 9, 9 out of 10 rating. How long did you wait to process a new member, a new consumer into your agency? You know, just learning to count. So then the challenge is that value based payments

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Fady Sahhar: are outcome, driven. And so they, we’re looking for ways that the agency or the provider can demonstrate that they have completed certain actions, and therefore those actions have resulted in the outcomes that we’re looking for. It’s not good enough for

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Fady Sahhar: somebody’s a 1 c. Score to be.

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Fady Sahhar: you know, still 7 7 point O forever, because that may have nothing to do with what the agency is doing so. The number one thing that I found is a challenge is for agencies to be able to gain that attribution, that ability to say I did this, and therefore I deserve the credit for the outcome.

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Fady Sahhar: And you know it comes in very simple ways. For example, I had in my early days in home care.

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Fady Sahhar: We had an individual who was helping a person was bedridden.

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Fady Sahhar: and while she was

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Fady Sahhar: getting that person out of bed every day, bathing them, and all that. She did not report to the agency that there was a sore developing on this person’s foot.

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Fady Sahhar: It took 6, you know, about 35, 40 days later, and nurse was visiting and observes the sore. Now the person needs to be hospitalized.

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Mike Paladino: Yeah.

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Fady Sahhar: That sort. So sometimes it’s like, the person showed up to work, did the work every day, but did not do the thing that could have prevented the hospital event or the doctor.

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Fady Sahhar: So it’s those kind of observation tracking and making sure that you’re knowing what you’re looking for medication. Compliance for many of our elderly people is a huge issue, and as a payer or as an agency. You want to be

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Fady Sahhar: appropriately training people not to not to make your consumer take their medication, but to remind them appropriately to to make sure that they’re eating the food that they need to consume while they’re taking certain medication, etc, so that the you do literally results in the outcomes that you say you’re delivering.

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Mike Paladino: Yeah, that story resonates with me regarding the soar. Right? Because that again, kind of alludes to the fact of like, you know, it’s the top down idea of you really want to set this the gold standard of care, and we can easily go and just mark off the tasks and kind of go through the motions of care.

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Mike Paladino: But if that no scenario, if we had properly documented it, even, you know, if we saw it. We just say, you know, I was tidying this, and I noticed there was a bit of a sore developing on the foot. Those notes are transferred to the care coordinator that care coordinator can see them. Maybe. Say, okay, we’re gonna monitor that on the next visit, if it gets worse, we’re gonna send the clinical team over to do, maybe a head to toe assessment. If from there maybe we can wrap it, clean, it.

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Mike Paladino: sterilize it, and then it prevents a readmission or a hospital visit. But if those things don’t get documented or we feel lazy, or we just simply didn’t care enough to do that which, unfortunately, sometimes is the case, then you have. It’s like the domino effect. Everything gets worse and compounds. So it’s really just going back to the quality of care and preventing. It is really a training effort and really a standard setting effort to really empower them

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Mike Paladino: to do the jobs well, but also recognize the jobs that are done well and incentivize them accordingly. Like you said earlier.

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Fady Sahhar: And but also keep in mind that it’s just as important for the care coordinator who receives that note. Maybe the caregiver actually

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Fady Sahhar: put in the notes that there wasn’t, but that that you know the caring and sufficient involvement to know that Yup, I need to go back and check on this again, or put something in my tickler file that in 3 days I need to go back and

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Fady Sahhar: ask the caregiver whether this has changed so.

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Mike Paladino: Yeah, yeah, I think there’s a lot. So I’ve done a lot of these podcasts and interviews. And I think there’s a few synonymous topics that we always seem to get back to, and one of them is communication effective communication. Did I know what I was supposed to do on my job, and if I did it right when I communicated it to know the next person in line. Was it clear? No. Did they accept that communication, and then communicate it to their next line in the process, and so on. So

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Mike Paladino: having that

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Mike Paladino: clear, and you know, concise communication really goes a long way. And also it’s acting upon those communications and knowing and understanding what’s being said and what the outcomes possibly are, good or bad.

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Mike Paladino: So I think that’s just a very common topic, no matter what we kind of land on, it’s really just being an effective communicator. And what’s in front of you understanding it and kind of thinking about the possible outcomes to that scenario. Because, again going back to that example you gave us, if you know, we’re providing we’re for homecare agency, right? We want

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Mike Paladino: Ultimately our clients to stay home. If they’re readmitted to a hospital, we potentially lose that client for a period of time. Or maybe they’re permanently in the hospital, that. And we’ve now lost a client. So there’s also a business side of this that has a big impact. If we’re not kind of doing the steps required to ensure the care is adequate, or you know, and so on.

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Fady Sahhar: Yeah, it’s

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Fady Sahhar: it’s. It’s a very challenging environment. And making sure all the links in the chain are working. Communication sometimes is

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Fady Sahhar: is also malign, because people will think that. Well, I gave them a poster, or I gave them a refrigerator sticker or.

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Mike Paladino: Yeah.

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Fady Sahhar: A and or I sent them a text, or or any of that. So it’s a

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Fady Sahhar: Sometimes we have to make sure that the communications being received.

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Mike Paladino: Follow through of it, too. Right? I like the way you put it. There’s a lot of leaks in the chain and

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Mike Paladino: There’s a lot of things that can ultimately break that chain of communication. If there’s something that gets missed right. So I think.

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Mike Paladino: as you mentioned. It’s a challenging industry. There’s always going to be a caveat here, there, but it’s really what are we doing to stay on top of it and just get better every day. Because again, our industry feels like it changes overnight. What’s acceptable today, or what system is the gold standard today might change tomorrow, or there might be a new State regulation might be something else. We gotta follow now. So it’s really just having that effective communication. But follow through on it as well. Just to make sure we are meeting the standard.

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Fady Sahhar: Yup. Absolutely.

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Mike Paladino: Awesome. So we talked about some challenges. Let’s now talk about some successes. So can you share any success? Stories of how value based payments have, you know, demonstrably improved care outcomes in your experience.

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Fady Sahhar: Yeah, it’s really interesting. I work with clients across the country. And I’ve had the opportunity to find that the more successful situations are the ones where there’s an involvement and a clear understanding of what it is. I’ll give you an example working with an agency in the Philadelphia area

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Fady Sahhar: recently, and there they had a group of diabetic consumers that they were focused on but these individuals lived at home

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Fady Sahhar: and they were, they were

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Fady Sahhar: prone to what I call the Saturday night boredom that led to somebody going to the emergency room. And so

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Fady Sahhar: this particular agency identified the what they call their frequent flyers, and they they approached their payer and said, We’re finding that these 12 individuals

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Fady Sahhar: are going to the emergency room at least once or twice every month.

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Mike Paladino: Wow!

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Fady Sahhar: And this is a big deal, and we’d like to see how we can help you avoid those costs.

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Fady Sahhar: And so in the process. They provided some diabetes training for the consumer they provided, and they provided training for the caregivers, but they also did things to adjust the schedule.

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Fady Sahhar: so that they were doing some things on Friday, and whenever they were working on Saturday, specifically targeted to identify what are the elements that were driving these individuals.

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Mike Paladino: Yeah.

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Fady Sahhar: Emergency room.

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Fady Sahhar: and then the easiest part of it was they. They set up a telehealth support. They said, If I’m not here and you feel the need to go to the emergency room.

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Fady Sahhar: call this number, and they had a nurse on the other end, and the nurse talked to them, said, you know, what are you experiencing? What are the things that I can help you with? And in, you know, there are times what the consumer needs to go to the hospital. No question, and we don’t want the person to not go if they require the care. However, by providing an intervention in a way that anticipated the behavior.

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Fady Sahhar: In a constructive way they were able to reduce that hospitalization rate very substantially.

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Fady Sahhar: and they were rewarded very well for it. I mean, that’s where shared savings and value based payments can be an amazing reward for an.

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Mike Paladino: Yeah.

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Fady Sahhar: All of a sudden. You’re not getting, you know, 12 cents an hour. You’re getting

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Fady Sahhar: the dollars.

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Mike Paladino: Yeah.

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Fady Sahhar: So it makes a big difference, and.

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Mike Paladino: That intervention is brilliant. I think you know that that’s an amazing way to solve, but that also comes down to the data that you receive right? And you can see the facts. And if you can just analyze them and understand what’s the root cause, you can then start to put solutions in place, which at the end of the at the end of it all, what does it do? Well, it increases the care outcomes, because now there’s less hospitalization.

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Mike Paladino: There is more trust gained which just again, it’s the domino effect. When you build that trust, you build that kind of relationship.

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Mike Paladino: They’re going to be more open and honest with you about what’s ailing them right? And B, you can provide better care. So it’s a nice way to think about it. I’ve not seen an example like that. So I just learned something new. And I think that that’s just a fantastic approach that more agencies can implement, because.

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Fady Sahhar: Count, you.

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Mike Paladino: Really that telehealth idea. I hope agencies do that more. My mom’s never done that, and I don’t know why. Now, thinking back on it. But

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Fady Sahhar: It’s emerging. It’s it tends to be, you know, an investment that you have to have a nurse on call available

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Fady Sahhar: during the times when you

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Fady Sahhar: usually don’t have a nurse available in a traditional agency. So but there’s some real innovative approaches that are taking place.

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Fady Sahhar: You know, another agency that I was recently involved in.

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Fady Sahhar: They, their player, wanted to make sure that their folks did 4 things every year. Go to your PC. Go to your dentist. Get your flu shot and get your covid shot.

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Fady Sahhar: And and they they basically

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Fady Sahhar: reached out to their payer and said, These are Hedis measures that you get star ratings for, and you get paid better when you have better scores, we wanna help you. And so they created a program where the caregiver was reminding the consumer, helping them set the appointment to go to their PC. Helping them go see their dentist, and

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Fady Sahhar: And then they paid them $25 for every time the consumer did that, and it was great. It was like a performance. They could demonstrate that what they did resulted in the 4 elements that truly improve this individual’s health.

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Mike Paladino: Yeah. And it. It almost seems obvious to do these kinds of things. But it allows you to kind of take a step back and think like, you know, when you really incentivize the individual to follow that structured approach or the 4 elements of success right? They earn more money. They have a better client in terms of care outcomes, and they’re likely to have a long term relationship with that individual because they.

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Fady Sahhar: Here, around the States.

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Mike Paladino: Exactly.

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Fady Sahhar: Better.

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Mike Paladino: Yeah.

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Fady Sahhar: Makes this person tick. So.

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Mike Paladino: Yeah, that’s such a great outlook on things. And honestly, I think it’s a brilliant approach.

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Mike Paladino: So the last question that I wanted to ask you today is, how are family members kept informed and also involved in the value-based care plan for their loved one.

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Fady Sahhar: But

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Fady Sahhar: it varies right. Not some family members look at the caregiver who’s coming into their home

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Fady Sahhar: as respite. Right? If you’re taking care of grandma, I don’t have to. And so some people don’t want a lot of information. The good news is, the vast majority of families want to be involved.

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Mike Paladino: Yeah.

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Fady Sahhar: And if they happen to be the same in the home with the individual receiving services.

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Fady Sahhar: then you find that the interaction between the caregiver and the family member becomes a very important dimension

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Fady Sahhar: of how the care is delivered, because there’s like permanent supervision. Right? They know, you know, if grandma is not comfortable, sitting in a robe that she wore for 3 days, and so on. So you’re as if you can. You can really provide that.

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Fady Sahhar: And we’re we haven’t gotten to the point where family members can earn

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Fady Sahhar: a part of what the value-based

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Fady Sahhar: rewards are. Yet.

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Fady Sahhar: because it’s the only place where I’ve seen it. Work is with consumer directed services, where? Where you have the consumer, employer, model, or the agency with choice model, where it’s a co employer model.

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Fady Sahhar: In those situations you find that the same kind of incentives that are being used with caregivers are being at least attempted with the family members.

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Fady Sahhar: But family members are also doing. When you have an elderly or disabled person in your home

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Fady Sahhar: that you’re providing these service the these supports for

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Fady Sahhar: It’s exhausting. And they we need to recognize sometimes that part of our role as as providers and as caregivers

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Fady Sahhar: is to make sure that we’re supporting them in the way that helps them be successful in caring for their loved one.

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Mike Paladino: Yeah.

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Mike Paladino: It’s so true. And I actually have a lot of agencies now under my portfolio that are doing consumer directed care typically in it for Medicaid. Right? We’re states where the family members, the caregiver. They’re now incentivizing and monetizing it. And I think it’s just a great approach, but also it allows them to.

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Mike Paladino: Really be, you know, involved in what’s going on and do kind of a better job at providing that care. And I always like to when you know the family, even if it’s not consumer directed when the family is really involved, like, I like to think my family is quite involved in my grandfather’s care.

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Mike Paladino: We communicate so everyone’s on the same page. If he has a bad day, we know about it. If he has a bad day, refuse something. We can help him get on the same page as the care, because we recognize it’s important to him to take his medications and things like that right? And I think that really just helps everyone feel more connected to the situation, but also have.

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Mike Paladino: you know, the confidence in their own responsibilities in the care. And now, whether that’s directly being the care provider or overseeing the care, authorizing what went on that day, and just being involved, all of these things, especially when you talk about a value based approach, are critical to success. Right? As long as everyone is aware of what’s going on, that’s going to make that situation much more fruitful for everybody.

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Fady Sahhar: Yes, I agree with you. And but it’s also, how do we create the environment where this engagement is? Also creating consistency supporting the proper interventions, without without taking away the

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Fady Sahhar: the ability of the person receiving the care the consumer from, to give up their right to what they want, and.

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Mike Paladino: Yeah.

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Fady Sahhar: I go back. I’m a person in a wheelchair, and I’ve been an advocate all my life, and so I know that it’s very important that the 1st and foremost, that we take care of the individuals dignity, that we treat them with respect, and that they are able to participate in life to the extent they wish and our job is to support them, not to tell them how to live.

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Mike Paladino: Yeah, exactly. It is beautifully said. And those are the rules that I think everyone should try to live by, especially in home care is just supporting the individual in a way that allows them to live their life. And I think that’s the most important thing.

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Fady Sahhar: Yep.

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Mike Paladino: Alright. Well, Patty, this is great. Thank you so much for sharing those amazing insights. I’m sure the audience got all the deep insights they’re looking for about value based payments and how that could help improve quality in home care

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Mike Paladino: to you. The wonderful audience thanks again for tuning in.

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Mike Paladino: And until the next episode. This is Mike signing off.

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Mike Paladino: Thanks, Buddy.

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Fady Sahhar: Thank you very much.