Quality in Home-Based Care

Home-based care plays a vital role in managing chronic conditions, aiding recovery from injuries, and enhancing mobility and independence for patients. While referring providers, patients, payors, and suppliers prioritize quality, there are no universal quality standards in place. For instance, patients care most about the comfort and convenience of the equipment, while referring providers typically focus on clinical evidence, patient comfort, and experience.

Unraveling the Definition of Quality

Defining quality for home-based care is not simple. Some major factors include compliance with quality standards set by regulatory bodies and insurance companies, equipment availability, accessibility, and affordability, as well as the timeliness, accuracy, and reliability of the delivery and service. Additionally, patient and referring provider satisfaction, outcomes, and feedback, along with equipment safety, effectiveness, and appropriateness, contribute to the determination of quality.

Considerations arise in the context of different fixed elements of Durable Medical Equipment (DME), such as HCPCS codes or size. There are over 2000+ HCPCs codes representing hundreds of products that should be treated separately.

Tomorrow Health's Data-Driven Approach

Taking cues from the supply chain industry, Tomorrow Health captures data at every touch point across the order lifecycle. We measure factors like order acceptance rates, response time, standard written order defect rates, and more, which are highly correlated with patient CSAT, a metric Tomorrow Health obsesses over.

Measures for Quality and Patient Outcomes

While some measures like the ones listed above are related to quality of service, others are related to outcomes. One such metric is CPAP compliance rate. We monitor suppliers’ ability to maintain patient CPAP compliance through detailed in-person training and ongoing support. We enforce this by prioritizing suppliers with high quality scores in order routing decisions, incentivizing high performance and leading to better patient outcomes.

The Impact of CPAP Compliance on Patients

CPAP compliance is a claims-based measure that ensures suppliers are continuing to provide the services and equipment necessary for patients’ ongoing therapeutic needs. Suppliers' role in providing ongoing support and knowledge about the machine greatly influences compliance. Factors like mask fitting, patient comfort, and confidence in using the machine also contribute to compliance, while the inconvenience of restarting therapy and the difficulty in obtaining support can lead to patient discouragement and discontinuation of CPAP usage.

Quality in Action

Let’s compare two home-based care providers using a few data points from Tomorrow Health’s proprietary dataset for a respiratory patient needing a CPAP machine.

If you were a patient newly diagnosed with COPD, which supplier would you choose? Imagine a world where Supplier B gets the majority of patient orders. This is happening today in many payor networks.

The Significance of Quality in Home-Based Care

The significance of quality in home-based care becomes apparent when considering its profound impact on patient quality of life. Home-based care today operates as a patchwork of opaque processes, sometimes leading to delayed discharges or creating logistical hiccups. At its worst, patients experience major setbacks in their health, worries escalate, and caregivers bear the burden of handling issues as they arise. By improving quality, we can enhance patient health and trust, while reducing the total cost of care.

Scaling Insights to Drive Quality

A core requirement of transitioning to value in home-based care is technology, not only to collect data, but also to drive accountability. Tomorrow Health's focus is to establish clear and consistent standards and criteria for quality in home-based care. We supplement this data with a collection of best practices for ordering, authorizing, delivering, servicing, and monitoring home-based care. By soliciting and acting on feedback from patients and providers to identify gaps and opportunities for improvement, we can consistently drive valuable service.

About Tomorrow Health

Tomorrow Health is a healthcare technology company enabling more efficient and reliable home-based care. We guarantee 15%+ savings for health plan partners while maintaining 90%+ member satisfaction for our health plan partners. To learn more about how Tomorrow Health can help your health plan maintain and automate clinical rules to ensure your members get the right level of treatment while managing utilization and spend, email partnerships@tomorrowhealth.com.