"Instead of it being described as home healthcare, in a few years the services performed by home health care agencies will simply be known as "modern healthcare". -Dr. Steve Landers, VNA Health Group, New Jersey

1. THE FUTURE OF HOME HEALTH: AXXESS TECHNOLOGY SOLUTIONS, INC. |
2014. ALL RIGHTS RESERVED.
‘A unique opportunity for home health agencies to learn how to position their
agencies for ongoing success, by staying informed and current in an evolving,
dynamic industry.’
C. Sam Smith
Vice President
Business Development
Presented by:
© 2013 Axxess. Unauthorized use is prohibited.
Merrily Orsini
Senior Business
Development
Executive

2. THE DYNAMICS IMPACTING THE FUTURE
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I. Demand for Services
A. The Impact of Demographics on Aging
B. The Impact of Chronic Disease on the future
II. Exhibits 1&2: The Care Continuum
III. The Regulatory Environment
A. Innovative Payment Systems Dynamics
B. Fraud Eradication
C. The ACA’s affect
IV. The Technology Dynamic
V. Infrastructure
VI. The Healthcare Workforce
VII. Research and Measurement
VIII. The Outlook from Our Perspective
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3. II. THE DEMAND WILL GROW AND GROW AND GROW
• By 2029(the next 15 years), there will be 71 million baby
boomers over age 65, an increase of 73% from today’s
numbers.(US Census Bureau)
• More and more physicians and hospitals are awakening to the
fact --that not only do patients want their healthcare in the
home, but Home Care is significantly less costly than hospital
or SNF care.
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4. II(A). THE IMPACT OF DEMOGRAPHICS OF AGING
• Requirements for more service exceeding supply of care
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providers
• Pay for service models emerging in ACOs, local non-profits,
proprietary businesses, physician practices
• Greatest transfer of wealth in the world’s history
• Naturally occurring retirement communities, and
congregant neighborhood aging communities
• Care recipients that are older, healthier, more demanding,
and with financial resources
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5. II(B). THE IMPACT OF CHRONIC DISEASE
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Milken Institute:
Every one of the 7
major chronic
disease
populations is
projected to grow
at a rate that
significantly
exceeds that of
the total
population.
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6. II(C) -WHAT CAN BE DONE ABOUT CHRONIC DISEASE*?
• Reduce the number of obese persons
• Continue the reductions in the public’s smoking
• Decline in Alcohol consumption
• Physical activity to increase
• High cholesterol will be reduced to pre 2000 levels
• An improvement in overall air quality
• A gradual decline in illicit drug use
• A modest improvement in early intervention and treatment
• Lower health care cost growth
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*According to the Milken Institute
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7. II(B). CHRONIC DISEASE: HOW CAN IT BE MANAGED MORE EFFECTIVELY?
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Milken
Institute:
Should the
initiatives of the
USA be
implemented
and carried
through,
significant
expenditures
could be avoided
by 2023.
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8. II.(B) - A MORE HOLISTIC LOOK AT THE CARE CONTINUUM
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9. II.(A) - THE CARE CONTINUUM
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Primary Care
Support
Post Acute
Care
coordinatio
n
Advanced
Illness Care
Expansion
Continuum
diagram-
Courtesy of
VNAA
Well/Healthy
AT RISK Chronic Care
Management
Complex Care
Management
Advanced
Illness
Palliative
Care
Hospice
Care
Coordination
across
providers
Preventing re-hospitalization
Care
Coordination
across
providers
Mitigation of
Risk
Promotion of
healthy
lifestyle
choices
Wellness
Prevention
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10. III. THE REGULATORY ENVIRONMENT
All future regulations are aimed at accomplishing the Triple Aim:
• Improving the patient experience of care (including quality and
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satisfaction)
• Improving the health of populations
• Reducing the per capita cost of healthcare
• Quality of Outcome: We will see an increase in the Systems and Methods
to enhance quality of outcomes. These include Care Pathways, care
monitoring techniques and reporting.
• Cost Containment Methodologies will grow—Bundled Payment Care
Initiatives [BPCI] - More BPCI’s will be active, moving patients along the
LTPAC continuum- (HH is the preferred provider and the low cost provider
and will receive most patient care tasks in the home)
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11. III(CONT.) REGULATORY ENVIRONMENT: ICD-10 IS NOT GOING AWAY
• ICD-9 to ICD-10 conversion is forthcoming, in spite of the delay to
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October 2015.
• We must be about training and preparation for this fundamental
change.
• With ICD-10, Healthcare workers will begin dealing with approximately
70,000 diagnostic codes rather than just under 7,000. The implications
for HHRG’s and reimbursement are significant.
• Axxess is preparing and will be ready for the code set change prior to
10-1-2015
• Axxess will be conducting training for all its clients for 2014 and
2015
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12. THE TRIPLE AIM OF HEALTHCARE REGULATION
Improve the
health of
the
population
Better care
experience:
Improve the
experience
of the patient
The
Triple
Aim
Reduce
Cost:
Improve the
affordability
of healthcare
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13. III. THE REGULATORY ENVIRONMENT(CONTINUED)
• Erosion of the Medicare 60 day episode, to outcomes based
discharges and cost containment, as well as other models created
because of changes in industry
• Medicare/Medicaid will continue to drive private insurance
changes, standard procedures.
• HIPAA compliance audits and enforcement actions are likely to
continue to increase as data security issues continue to proliferate.
• Regulators and Insurers, and BPCI Convenors will rapidly
recognize the value of home health due to its cost drivers
versus hospital and SNF costs. However, because of the
payment per episode, a less expensive alternative is being
sought as well.
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14. III(A). INNOVATIVE PAYMENT SYSTEMS DYNAMICS
• The system is fragmented, in silos, and non collaborative, but it is moving to
cohesive collaboration, centered around Population Health Management
• Payment Systems being organized in regional markets
• A slow evolution. Payment has been driven by specialty along the continuum, it
will become more and more outcome and value driven
• Revenue earned by the HHA will be because of its positive patient outcomes
• Regional Systems are slowly moving towards Meaningful Use, meaning
interconnectedness of the technologies of hospitals, physician clinics, SNF's, and
HHA data.
• Bundling of services under a central “Convener”, such as a hospital, an ACO, a
healthcare system is slowly progressing.
• Bundling will yield payments being made to the BPCI, then carved out and paid to
the various participating providers, per Service Agreement
• Home Health will emerge as the patient favorite, as well as the bargain of all
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stops on the continuum
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15. III.BPCI POPULATION HEALTH MANAGEMENT RISK / CHRONIC DISEASE
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Actuaries will weigh the
Population Segments,
according to Risk of
Hospitalization, according
to probable outcomes of
the patient population.
Insurers “weigh” the
relative risk of each strata
of risk.
Key determinants: Cost of
Care, Patient Satisfaction.
In all aspects of bundled
payment, between
Physician Clinic, Hospital,
Skilled Nursing, Home
Health, Personal
Assistance-Home Care,
which of these services
would be less costly to the
payer?
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16. III(B). FRAUD ERADICATION WILL CONTINUE
✓ The Feds ability to mine data and detect the fraudulent activity will get
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more and more adept.
✓ The HEAT* is on, and will remain on until the levels of fraud are on the
decline.
✓ ZPIC’s and RAC’s will do their work- “Boots on the ground”
✓ Moratoria in place in FL, IL, TX, MI…this will continue
✓ Fraud is the “vermin” of Home Health, honest, hard working agencies
want this to be under control, but without unnecessary regulatory
burdens
*Health Care Fraud Prevention and Enforcement Action Team (HEAT)
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17. III(C). THE ACA WILL ROLL ON AND ON
• F2F, other possible changes that may take place
• Medicaid expansion will be promoted more heavily
• The ACA calls for more and more transparency for healthcare costs.
Hopefully, this will work towards home care’s benefit over time.
• Electronic technology in healthcare will continue to be promoted.
• Paper filing may indeed be formally discouraged and potentially
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eliminated.
• As Insurers are more involved, more insurance providers will start seeing
the benefits of home healthcare.
• Costs will be reduced with increasing innovation, and more use of
technology within the system as well as ancillary to the system.
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18. © 2013 Axxess. Unauthorized use is prohibited.
Readmission rates

19. IV. WHICH WILL TECHNOLOGIES WILL EMERGE FOR HOME HEALTH?
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What Technologies
will have the most
impact in the delivery
of care?
What are some other
emergent technological
advances?
Apple, Samsung,
LG and others are
coming into
healthcare
RPM- Bluetooth
Connectivity
Mobile apps for
EVV, Care Plans,
HIPAA Compliant
Messaging
Tele-Health:
Video
conferencing
between patient
and care giver
Care Coordination
Data Transfer:
HL7 & in the
Cloud
Medication
management
integration
Google Glass:
Wearable
Technologies:
Head bands,
clothing,
monitors installed
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20. IV. THE TECHNOLOGY DYNAMIC
Emerging technologies that are impacting or will impact care delivery in
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the home/community
•
• Apple, Samsung, and LG are all offering healthcare based technologies from the mobile perspective.
Apple announced a collaboration with Epic and Mayo Clinic.
• Google Glass: Vision based diagnostics; Wearable Tech: Fierce IT predicts $6B market by 2016
• Bluetooth connectivity: RPM- Remote Patient Monitoring coupled with simply mobile tablet and smart
phone technology
• GPS enabled Mobile applications for Visit Verification, Mapping, Scheduling; tied to central database;
Including Care Plans; HIPAA Compliant Messaging
• Medication Management data access for EMR- reconcile prescriptions to what is in the home
• Telehealth: The use of video conferencing for Face-to-Face Doctor-Patient Conversations, Nurse-
Patient Conversations
• Physician/hospital/LTPAC communication: Cloud based coordination has potential, enabling Private
Personal Health Information[PHI] transfers upon discharge from hospital and admission to HH,
bypassing the HIE process
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21. V. INFRASTRUCTURE
• Uncertain future: A Nationwide framework for data exchange is
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years from being in place
• Each city, each regional market is unique, and generally
fragmented or monopolized
• Interconnected vendor systems; Epic and everyone else in Primary
Care- Is there interconnectivity? Will there be?
• Collaboration? No, instead its Competition
• RHIO/HIE : Is the answer in the cloud?
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22. VI. THE WORKFORCE FOR HEALTHCARE
• The AHHQI Future of Home Health project will seek to assess
and measure the workforce necessary to provide service for
the 73% increase in general demand for healthcare due to the
demographic shift.
• Big adjustments are needed in society in order to
accommodate this generational change
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23. VII. RESEARCH AND MEASUREMENT
The Institute of Medicine’s “Future of Home Health” project
workshop, led by the Alliance for Home Health Quality and
Innovation, is sponsored by Axxess, and C.H.A.P.( Sept. 30-
Oct.1)
The project will be looking into the issues facing home health’s
future in the health care continuum.
The findings of this project will be shared with the government
and private sector with conclusions for change initiatives.
Plus Axxess will share the results with its clients!
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24. VIII. THE OUTLOOK
The Secrets to Success for home health agencies will
reside in the following traits:
 Flexibility
 Adaptability
 Continuous Learning
All systems, from internal to external, will need a focus on
interoperability and inclusion:
 Across types of service
 All players in the health care continuum
 Technology
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25. VIII. THE OUTLOOK #2
✓ Home Health Agencies that are adaptive and can utilize their HH
technology effectively will be able to survive and thrive
✓ The "smart" and "agile" agencies are the fittest and are in the best shape to
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effect survival mode
✓ Ability to utilize the EMR data and apply it to aid the hospital bundling
initiatives in lowering cost of patient care overall
✓ Axxess provides the industry's most adaptable, scalable and
comprehensive platform for weathering the future changes that are sure to
occur in the Home Health Industry.
✓ “ Axxess = Everywhere!” 24

26. RESOURCES AND LINKS
Alliance For Home Health Quality and
Innovation
http://ahhqi.org/home-health/future-project
Read more: 5 ways Google Glass will innovate
healthcare - FierceHealthIT
http://www.fiercehealthit.com/story/5-ways-google-glass-will-innovate-healthcare/
2014-04-11#ixzz326jVTsKl
The Future of Home Health/ ARTICLES for further
reading…in this folder
https://www.dropbox.com/sh/le062ptfuincedj/AAAwnc1Pj
SpDko-krWE8T_bua
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27. THANK YOU FOR YOUR ATTENTION AND
PARTICIPATION
If you have any questions, we would love to
try and answer them!
Following this presentation, our Axxess
representatives will be going over features and
enhancements of our software if you would like to
see them. Otherwise, have a great day.
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THE FUTURE OF HOME HEALTH