Home' The Source : Second Quarter 2015 Contents Trinity Health, which serves 21 states with 86 hospitals and
128 continuing care facilities, has made a commitment to taking
healthcare to its communities through extensive home health-
care services. Its Trinity Home Health Services (THHS), based in
Livonia, Michigan, is the nation's largest not-for-profit provider
of home healthcare services, ranked by number of visits. Recent
supply chain changes have allowed THHS to improve its services
as well as its bottom line.
For instance, rather than having clinicians drive to the o ce to
pick up supplies before making patient home visits, supply chain
professionals implemented a direct-to-patient delivery program that
reduced mileage costs for clinicians, freed up o ce sta time and
storage space, and allowed clinicians to visit more patients per day.
In addition, THHS developed a formulary of clinically approved,
best-value products that enable more consistent clinical outcomes
across all sites, as well as better pricing and availability of products.
The formulary program is realizing a 90 percent compliance rate
and, at one site, savings have totaled $40,000.
THHS continues to identify new ways to produce better outcomes
with lower costs. For instance, the organization recently reduced
the number of di erent INR (finger stick) machines to one stan-
dard type, allowing purchasers to buy accompanying supplies at a
volume discount. That step will achieve a reduction in costs as well
as standardization and ongoing quality assurance, says Barbara
Samson, director of clinical services at THHS.
"We have standardized our processes as much as possible to reduce
waste, and we are in the midst of switching our EMR software, which
we anticipate will reduce costs in the long term," Samson says. "We are
continuously looking at new products and equipment that will allow
us to deliver care at a lower price and reduce our number of visits."
Pursuing Newer Models
After achieving some success, THHS began exploring other types
of care delivery models. The organization is currently launching
Transitional Care, a new program for patients being discharged
from the hospital who do not qualify for regular home care but
need some type of follow-up.
"For these patients, we have either the hospital or insurance
companies contracting with us to provide one home visit by a reg-
istered nurse for medication reconciliation or disease management
teaching, and then we will do weekly phone calls for five weeks to
review medications, assess health status or instruct on emergency
plans," Samson says.
THHS is also experimenting with di erent types of bundled
payment initiatives. Many such initiatives involve package pricing
for the standard care provided for certain conditions, but THHS
is trying bundled payments for other services, including hospi-
"We think of our bundled payment initiatives as pilots," Samson
says. "We are proposing di erent ways of delivering care to see what
achieves the best outcomes of better care and lower costs. Ultimately,
we will deliver more e cient and coordinated care, decrease redun-
dancies, and increase the health of our populations."
These new models of care are all focused on two outcome
metrics: reducing costs and reducing rehospitalizations. "If our
costs are not as low as they can be, we will not be awarded the
contracts to provide these new and emerging modes of care,"
A number of health systems are pursuing other methods of provid-
ing care in nontraditional ways to achieve better outcomes and cost
e ciencies. They may be converting beds to other uses, moving to
ambulatory sites, employing physicians or starting their own health
plans, Murdock says. One common example is the conversion from
the Medicare Shared Savings Program to a Medicare Advantage
Prescription Drug (MAPD) Plan, she adds.
Murdock predicts there will be more changes to reimbursement
and greater experimentation. For instance, she expects that pay-
ments will be increasingly tied to performance, as with the Medicare
Star Ratings used by MAPD plans. These ratings measure how well
plans perform based on a cross section of quality metrics, including
customer service, member complaints, managing chronic conditions
and preventive care. Murdock also forecasts that more populations
will be risk-adjusted as they currently are for MAPD programs and
the state health insurance exchanges.
A REVOLUTION IN CARE
Trinity Home Health Services
developed a formulary of clinically
approved, best-value products
that enable more consistent
clinical outcomes across all home
healthcare sites. The program is
realizing a 90 percent compliance
rate and at one site, savings have
30 The Source | Second Quarter 2015
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