New incentives for hospitals are improving quality of care for patients at home

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New York resident Rodney Nelson said that his 77-year-old mother receives medical support from her one-bedroom apartment in the Upper West Side of Manhattan.

Under her Medicare plan she is able to have a trained home aide come to visit her daily to help with tasks such as cooking and cleaning, Nelson said. The aide will also check in on Nelson's mother and provide social support. Every three months, a registered nurse will visit to evaluate her health.

"If she feels she needs to see her nurse sooner, she can call her primary-care physician from her smartphone and that may trigger an earlier evaluation," Nelson told CNBC.

Nelson said the home accommodations, set up between him and his mother's health-care providers, allow her to maintain her independence while also getting the support she needs. He said his mother, who is now retired, preferred to stay at home rather than in a hospital or a skilled nursing facility.

This situation is one example of how health care looks for the elderly and disabled patients at home in the U.S., some of whom are reporting signs of increased quality of care.

A recent report from The Commonwealth Fund found the percentage of home-health patients who got better at walking or moving around, a key measure of quality of care, rose in every state from 2013 to 2016. The group, which tracks performance in health systems nationwide, also found that hospital readmission rates for elderly Medicare beneficiaries continued to fall in nearly half the states from 2012 to 2015.

The improvement in care at home comes at a time when hospitals are forced to alter the way they deliver care, which can include providing more outpatient services or consulting patients online. Hospital admissions and length of stays have slumped in the U.S. over the years as more people are seeking cheaper alternatives or looking to fulfill their health-care needs more conveniently.

Additionally, the improvement in home-based care comes as incentives created under the 2010 Affordable Care Act, more commonly known as Obamacare, are encouraging cooperation among health-care providers, including hospitals, to reduce unnecessary health costs and keep people from being readmitted.

Under the Medicare Shared Savings Program, providers can form what is known as an Accountable Care Organization, or ACO. Under ACOs, health-care providers take on the responsibility for coordinating medical care for patients from the doctor's office to home care, in an effort to improve health outcomes and reduce overall costs. ACOs that successfully lower costs for their patient population are rewarded through bonuses.

This program is good news for people on the receiving end of care too, David Grabowski, a health-care policy professor at Harvard Medical School, told CNBC.

Because providers are attempting to avoid that costly trip to the hospital, they will regularly come to the patient's home to assess safety risks and ensure there is a good quality of life through activities and medication reminders, Grabowski said. Moreover, Medicare patients, who are older and typically have weakened immune systems, are less at risk of getting infections at home as opposed to a nursing facility or hospital, he said.

There's an added physiological benefit from being at home as well, Grabowski said. Patients who are at home, sometimes surrounded by family, typically feel more satisfied with their health situations, said Grabowski, whose research examines post-hospital care, including home care and nursing facilities. "I'm sure everyone would rather stay at home than in some random hospital bed."

Separately, it's worth mentioning that consumer technology such as smartphones has also played a role in improving care at home, said Cindy Krafft, a care consultant who helps families and agencies figure out how to care for their elderly or injured relatives at home.

Krafft, CEO of Kornetti & Krafft Health Care Soultions, said home care "feels less isolated" and ACOs and other providers are able to provide a higher level of care than they were able to a several years ago.

What's next for home-based care

More patients who want to stay at home should be able to as the Medicare Shared Savings Program has continued to add several ACOs each year. The Centers for Medicare and Medicaid Services said there are 561 ACOs participating in the program so far this year, up from 480 in 2017 and 433 in 2016.

And there is a desire among ACOs to continue to improve the quality of care at home.

Dr. Steven Strongwater, president and CEO of Massachusetts-based ACO Atrius Health, told CNBC that his company is working with a health-care technology and services company, Medically Home Group, to help patients avoid hospitalizations all together and receive advanced medical care at home.

"I believe health-care generally will continue to move from the hospital to the home over time, said Strongwater, who helps deliver coordinated medical, home health and hospice care to 720,000 patients across eastern Massachusetts.

Mark Wagar, president of Northridge, California-based Heritage Medical Systems, one of the largest pioneer ACOs, told CNBC that his company recently began operations in New York for health-care workers to visit patients at home. He said, among other benefits, visiting patients at their home allows providers the chance to educate patients about their health.

"Helping [patients] understand their home situation is critical if you want to make a difference," Wagar said.