| Home health care patients often have multiple chronic conditions. Sources vary, but it is believed that 86 percent of Medicare home health patients have three or more chronic conditions (Avalere, 2010). This module includes evidence-based practices, procedures and protocols for addressing specific clinical conditions.
Although specific clinical interventions may vary according to the patient's diagnosis, many home health interventions are cross-cutting. Home health agencies will need consistent, standardized processes for initiating care, evaluating and addressing patient risk factors, and ensuring that the agency provides a good experience to the patient and caregivers. Functional status is a critical driver underlying readmissions and emergency department use, and should always be part of care planning.
Agencies will need to continuously monitor performance through Home Health Star Ratings and Home Health Compare. Agencies should also anticipate future measures reported for the IMPACT Act.Finally, agencies need to ensure that they offer value to referral sources, patients, and other providers as the system increasingly moves to a value-based purchasing model of financing.
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