Home health has become a critical component of regional integration efforts of multihospital systems.
As they build integrated delivery networks, systems are seamlessly linking home health with primary care, acute care, long-term care and hospice care.
"Integrating home care allows the emerging networks to manage their costs more effectively by working with physicians to coordinate early discharges and (sometimes) to avoid hospitalizations altogether," said Daniel Rothery, director of SSM Home Care, a subsidiary of St. Louis-based SSM Health Care System.
The number of home health services provided by systems such as SSM has ballooned over the last several years, primarily to control costs. Besides nursing services, system-based home care includes infusion therapy, physical therapy, occupational therapy, renal dialysis, durable medical equipment, hospice care and intravenous therapy.
Although an estimated 60% of the home health industry is controlled by home-care chains, systems and their hospitals also have been adding home care to their service mix.
In 1994, 137 systems reported that 719 of their hospitals provided home-care services, a 24.4% increase from 1993, according to MODERN HEALTHCARE's 1995 Multi-unit Providers Survey.
SSM is an example of a system using a combination strategy: acquiring local home health agencies and signing affiliation agreements with established home-care companies. SSM has 18 hospitals and six nursing homes in six states. In 1995, SSM Home Care generated 500,000 home visits. Rothery projects 10% to 20% growth this year. "We are integrating home health in our (regional) networks based on local market conditions," Rothery said. "We aren't using a cookie-cutter approach."
Hospitals have traditionally done a poor job of integrating home health because they have treated it as a revenue-generating department of the hospital and not as a vehicle to reduce costs, Rothery said.
"Layers of bureaucracy and slow decisionmaking at the hospital level impede development of home health," Rothery said. "Systems have the broader view of inpatient, outpatient and physician services."
Systems also have the money to spend on developing information systems that will link financial and medical records with inpatient and outpatient care.
"We are incorporating home health into our information system strategy," Rothery said. "We aren't there yet, but we are getting close." Many of SSM's home health nurses are equipped with laptop computers to exchange data with the system's computers during patient visits, he said.
Another system developing a regional approach to home care is nine-hospital Promina Health System, based in Atlanta. Promina, which was formed in October 1994, comprises four not-for-profit hospital groups.
"We have a variety of arrangements within our system," said Bernard Brown, Promina's president and chief executive officer. "One of our systems has a home healthcare division."
To provide complete coverage for its service area, Promina contracted last year with Visiting Nurse Health System, Atlanta, Brown said. VNHS is Georgia's largest home health ccompany, serving the Atlanta and Savannah regions.
"The conventional wisdom was that home healthcare providers needed to become legal partners within an integrated delivery system," said Kathy Ziegler, VNHS president. "Providers can work together interdependently to ensure cost-effective care for patients while remaining separate legal entities."
Another Atlanta provider, Georgia Baptist Health System, has decided to build its home health services through acquisition. It recently acquired Morrow, Ga.-based Liberty Home Health for an undisclosed amount. The acquisition gives Georgia Baptist home health services in 22 of the state's 99 counties. The system is the parent of 533-bed Georgia Baptist Hospital and other diversified health services.
States also are responding to the cost-containment potential of home care by encouraging its growth.
In Alabama, for example, the state's health plan for 1996 through 1999, which guides facility and service development, was revised to encourage home health, assisted-living facilities and adult day-care centers. The change was to give patients a lower-cost alternative to nursing homes and hospitals.
"What we're doing is attempting to identify those components of care for the elderly that meet their needs at the lowest possible cost," said Elbert Peters, executive director of Alabama's health planning and development agency in Birmingham.