One of the most important Centers for Medicare & Medicaid Services (CMS) leaders – Dr. Meena Seshamani – is optimistic about the future of the home health care industry.
She detailed why last month at Home Health Care News’ Capital+Strategy event, pointing to more care taking place outside of traditional facilities, innovative care models and the shift to value-based care in general.
“We in Medicare are looking to increase our footprint in value-based care and in holistic care models where you’re really encouraging that team-based approach to care,” Seshamani said. “You’re enabling providers to come together to take accountability for cost and quality.”
Seshamani is the deputy administrator at CMS and the director of the Center for Medicare. In a value-based-care model, the shared goal of keeping patients healthy and out of the hospital drives smarter spending, she said. More importantly, it will ideally put providers, payers and other stakeholders in a position where they’re all “rowing in the same direction.”
“When something works in innovation, we have data, we have transparency,” she said. “As you align the various models that are out there, as you grow those models, that enables some of the flexibility to be able to address the needs of people that you are caring for.”
Once the data is there and innovative projects and alignments prove successful, Seshamani said the next step is to scale it.
An example of a successful pilot model is the Home Health Value-Based Purchasing (HHVBP) Model. A Center for Medicare and Medicaid Innovation (CMMI) creation, the model is being expanded nationwide next year.
According to Seshamani, there are two questions that CMS has to ask before it launches any model: whether it improves quality and whether it saves Medicare money.
HHVBP is one that met both of those criteria. Seshamani said CMS is now scaling it in order to bring it to more people.
“Think about testing things with an eye towards, ‘If it works, we can scale it.’ Because there are plenty of pilots that were great as pilots but then couldn’t be scaled,” Seshamani said.
When considering growth and alignment in the home health space, Seshamani said CMS will want to make sure it advances equity, encourages quality and person-centered care and promotes the sustainability of the Medicare program.
Optimizing the Medicare program is another key for Seshamani and the rest of her team. She believes Medicare Advantage (MA) will play a big role in that in the coming years.
“With that in mind, [we’re] thinking about where and how Medicare Advantage is innovating: Where are there things that are working? Where are there things that maybe are not working so well?” she said. “Is it moving the needle on outcomes? Is it spending the Medicare dollar in a smart way?”
MA is undoubtedly going to be a major part of where the health care system goes – and where the home health care sector goes – over the next decade. Over the past couple of years, home health agencies have gotten increasingly skeptical of MA, however.
Seshamani did say that as MA grows, more oversight would be needed, especially on things like supplemental benefits.
Still, Seshamani said the most important thing she’s looking forward to in her role at CMS is how to move the needle on care delivery innovations and holistic care models to “advance equity, improve quality and be better stewards of the Medicare dollar.”
“I think that really has to happen in partnership with providers,” she said. “If you have providers that are working towards these goals, we need to be able to facilitate connecting the dots.”
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