‘Why Not Home?’ Program Improves Efficiency of Care Transitions
Why Not Home? is a new program designed to encourage more transitions from hospital to home with healthcare support instead of from the hospital to skilled nursing facilities (SNFs). Data show a positive effect on costs.1
Research showed the rate of SNF discharges per 1,000 patients declined from 73 per 1,000 to 70 per 1,000 patients in the postintervention period. The total SNF cost increased by 3% postintervention, despite the overall growth of 10% among the patient population in the same period.
“The results of our study imply that this multifaceted intervention was aimed to shift that traditional care and discharge planning paradigm to consider the question of Why Not Home? and to wrap around resources in the least restrictive environment,” says Kelli A. Chovanec, DNP, RN, NE-BC, lead study author and system director for care navigation of ProMedica health system in Toledo, OH.
A segment of the population will always require a SNF level of care, but some of those sent to SNFs could do as well or better at home with home health services. The program aims to send each patient to the best level of care for that person.
“We help to make that shift of value-based care, and it’s an effective strategy for accountable care organizations [ACOs] that are hoping to ensure patients are getting the right level of care at the right time, and to improve utilization and expenditure of post-acute care services,” Chovanec says.
Case management leaders discovered the need for a change after reviewing discharge data. “When we were looking at our skilled nursing facility discharges across different populations, specific to the ACO, we realized we were sending a high volume of patients to the skilled nursing facility level of care, compared with other benchmarks,” Chovanec says. “We looked at what’s driving our volume of patients to SNF discharges and identified an opportunity to implement the Why Not Home? strategy to make sure patients are going to the least restrictive site of care.”
A retroactive claims review compared patient outcomes between those who were discharged from the hospital to SNFs and those discharged from the hospital to home healthcare. Investigators found the patients sent to an SNF were five times more likely to be readmitted than were those who went home with home healthcare.2
“We know outcomes are optimal when patients go to the least restrictive level of care, and this started us on the Why Not Home? campaign,” she adds.
Asking Why Not Home?
The first step was to staff Why Not Home? with interdisciplinary team members, including case managers, discharge planners, social workers, and therapists (including speech therapy, occupational therapy, and physical therapy).
“We targeted them for the educational component of this and focused on providing an overview of the value-based care tenet,” Chovanec says. “We provided information about the previous study on how patients discharged to the home setting were five times less likely to be readmitted.”
Leaders asked team members to ask Why Not Home? during interdisciplinary team meetings.
“The goal is asking Why Not Home? in order to make sure we’re getting folks to the right place of care,” says Amanda Beck, ABS, director of care transformation at ProMedica. “For those who can go home, then that’s the right place for them. But how do we get them there? How do we get the folks who need a skilled nursing facility there?”
Before launching Why Not Home?, case management leaders recognized variation in clinicians’ recommendations and referrals.
“Some clinicians aimed for the highest level of care,” Chovanec says. “Within the value-based paradigm, which is what we’re all, hopefully, marching toward, it’s the opposite. We want to be prudent users of healthcare dollars, and we want the least level of care and wraparound services that the patient needs.”
The team’s mantra is to give patients the right level of care in the right place and at the right time.
Understanding Barriers
In starting the Why Not Home? team, it was important to make sure the leaders understood the goals. “Kelli and I did a road show, [going] hospital to hospital with these leaders and having conversations where we’re open to outcomes and findings, and open to understanding the frontline barriers they encounter every day,” Beck explains.
Barriers include financial challenges, social determinants of health, home condition barriers, and other things that impede moving patients to the next level of care.
“We knew we had to present the data to them and make a compelling case for them,” Chovanec says. “We had to show that clinical outcomes were really great when they were discharged to the home care setting. The leaders responded very well to those data.”
Early on, the case management team recognized the Why Not Home? program would drive a paradigm shift and send higher-acuity patients home.
“We engaged our home health team members with part of this and challenged them,” Chovanec explains. “We said, ‘If we’re sending higher-acuity patients to your setting, what is your capacity to serve them?’”
The home health agencies provided specialized training and education for their home health clinicians so they could handle these higher-acuity cases.
“It’s important to note that in our study, the total accountable care organization-attributed patient population increased by 10%,” Chovanec says. “But the SNF cost only increased by 3%.”
This suggests the ACO saved hundreds of thousands of dollars in costs because patients were sent home when clinically appropriate.
“What we discerned from this study is our Why Not Home? campaign was directionally making an impact for the ACO population in terms of volume of patients discharged to skilled nursing facilities or home care,” Chovanec says. “Since the study period in 2019, this trend has accelerated even more as the COVID-19 pandemic has served as a catalyst for this project. We would expect to see an even larger decrease in transitions to SNFs in 2021.”
Why Not Home? has resulted in patient benefits, as many patients prefer discharge home with supportive services instead of discharge to a SNF. It has provided cost benefits.
“The primary reason we feel so passionately about this is it’s the right thing to do,” Chovanec adds.
REFERENCES
- Chovanec KA, Arsene C, Beck A, Liedel B. Why Not Home?: A study of the impact of an effort to reduce postacute expenditures. Prof Case Manag 2022;27:3-11.
- Chovanec KA, Arsene C, Beck A, et al. Association of discharge disposition with outcomes. Pop Health Manag 2021;24:116-121.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.