Post-Acute Home Health Care for Veterans: Examining Payer Source, Quality, and Outcomes

Providence Va Medical Center, Providence RI

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Background. Veterans are at increased risk of adverse outcomes after hospital discharge, including rehospitalization, nursing home admission, and mortality. Post-acute skilled home health care (HHC) can provide critical support for Veterans following a hospitalization. The services provided through HHC, including nursing and therapies, can help Veterans meet their goals to improve function, well-being, and return to independent living in their homes. For Medicare-eligible Veterans, skilled HHC is provided through 1) VA purchased skilled HHC from a contracted HHC agency or 2) Medicare-funded HHC (i.e., Part A benefit, Medicare Advantage). Preliminary work suggests that the majority (66%) of Veterans discharged home from VA Medical Centers (VAMCs) with skilled HHC receive VA-contracted skilled HHC and the remainder receive Medicare-funded HHC. However, funding for skilled HHC varies substantially across VAMCs, with implications both for HHC service delivery and Veterans’ outcomes. In preliminary work, we found that 30-day readmissions are higher among Veterans who receive VA-financed HHC compared to Medicare-financed HHC, which could be related to HHC agency quality. Significance/Impact. A better understanding of HHC referrals and financing, which has always been purchased and delivered by community HHC agencies, could provide key insights for the VA given the growth in community care for Veterans. Because community home health agencies have always provided post-acute HHC, this context provides an ideal opportunity to examine interorganizational partnerships and Veterans’ outcomes. The proposed research will characterize post-acute HHC use, financing, and quality of care, and how these factors are associated with outcomes for Veterans discharged from VAMCs, as well as providers’ and Veterans’ experiences of delivering and receiving post-acute HHC. Findings will inform the development of a toolkit for VA and HHC leaders with resources to guide high-value HHC agency selection and collaboration. The contribution of this research is significant because the results will directly inform how operational partners choose HHC agencies to include in provider networks and develop policy for skilled HHC referrals, and will also provide practical tools for multiple stakeholders to provide optimal HHC for Veterans. Innovation. This is the first comprehensive study to examine VA contracting, referral practices, and financing - including both VA and Medicare - to understand their influence on Veterans’ outcomes. A stakeholder- engaged, complex mixed-methods study design is used to understand the mechanisms and processes that shape the use and outcomes of post-acute HHC from multiple perspectives. Specific Aims. 1) Identify determinants of VA vs Medicare-financed post-acute skilled HHC among community dwelling Medicare-enrolled Veterans; 2) Understand multiple stakeholders’ perspectives on older Veterans’ use of post-acute skilled HHC and factors that influence the delivery of HHC; 3) Determine the impact of home health agency quality and HHC payer source on differences in outcomes for older Veterans receiving post- acute HHC. Methodology. This proposal uses a complex mixed-methods study design with advanced statistical techniques and comprehensive VA and Medicare administrative data, as well as a robust qualitative approach to interview stakeholders from VAMCs, HHC agencies, Veterans, and caregivers to accomplish our aims. Implementation/Next Steps. The culmination of findings from this work will be incorporated into a toolkit to promote high-value HHC selection and collaboration. In addition, this work will form the foundation for a large- scale study to develop and test implementation and effectiveness of a shared decision-making model for Veterans and VAMC personnel to promote high-value HHC.