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We were able to identify seven research articles regarding the most recent outcomes and evidence specific to alternative payment models for rehabilitation and therapy in home health care. This includes the report of the U.S. Department of Health and Human Services from 2015, a report made by Health Care Payment Learning & Action Network, current data research on APMs, an academic paper titled "Alternative payment models lead to strategic care coordination workforce investments" that identifies patient-centered medical homes, accountable care organizations (ACOs), and bundled payments as the most commonly cited and discussed alternative payment models.

The following three papers ("Bundled Payments: Value-Based Care Implications for Providers, Payers, and Patients", "Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices", "Accountability across the Continuum: The Participation of Postacute Care Providers in Accountable Care Organizations") provide in-depth research on these three alternative payment methods in regards to rehab therapy and home healthcare. For each paper, outcomes regarding home healthcare specific to rehab therapy and alternative payment models have been identified.

1. OVERVIEW OF ALTERNATIVE PAYMENT METHODS

U.S. Department of Health and Human Services (HHS) announced its goals regarding the shift in payment methods for healthcare in 2015. HHS’s goals are twofold:
"1. To tie 30% of traditional (fee-for-service [FFS]) Medicare payments to quality and value through alternative payment models (APMs; including bundled payments or Accountable Care Organizations) by the end of 2016 and 50% by the end of 2018 and
2. To tie 85% of all traditional payments to quality or value by 2016 and 90% by 2018 through programs such as Hospital Value-Based Purchasing Program (HVBP) and Hospital Readmission Reduction Program (HRRP)."
While the Affordable Care Act (ACA) focused mostly on hospital care, HHS's goals and programs are targeted towards skilled nursing facility (SNF) value-based purchasing and home health value-based purchasing.

Overall, "risk bearing providers are increasingly utilizing home health care" because it has the effect of reducing the "total cost throughout episodes or enrollment periods". The results from research done in 2016 show that Medicare payments were lower compared with comparison groups for home health care ($11,311 vs. $16,896).

2. Alternative payment models lead to strategic care coordination workforce investments

In this paper from 2017, the authors (Erikson et al.) examine "the role of alternative payment models and payment reform". They selected four health systems that "were at different stages of adoption of risk-based contracts and were engaged with different payment programs, including Medicaid reforms, Pioneer ACOs, Next Generation ACOs, Medicare Advantage, and commercial Shared Savings ACOs". As part of the paper's discussion part the authors state: "We found that each of the organizations in our study has made a significant investment in their care coordination workforce in response to alternative payment models. This reinforces the power of creating new financial incentives that reward a greater focus on care coordination."

3. APMS hold a third of total us healthcare payments

Almost one third of overall U.S. healthcare payments are tied to alternative payment models (APMs), states a report made by Health Care Payment Learning & Action Network (LAN), "a public-private partnership launched in March 2015 by the U.S. Department of Health and Human Services to drive adoption and alignment of APMs". They discovered that 29% of payments, or $354.5 billion, were "tied to APMs, a six-percentage-point increase from 2015 to 2016".

4. PAYMENT REFORM SYSTEMS

A 2017 paper titled "Payment Reform for Better Value and Medical
Innovation" by McClellan et al. cites patient-centered medical homes, accountable care organizations (ACOs), and bundled payments as "the most commonly cited and discussed alternative payment models". The paper also quotes some conflicting early financial results regarding ACOs: "The early financial performance of MSSP ACOs has been found to be highly variable (across ACOs and geographically)—with some ACOs generating major shared savings, and others more marginal shared savings. Early findings also indicate that large ACOs do not have an advantage over smaller ACOs in terms of financial performance, and that there appears to be no meaningful association between initial financial performance and overall quality. In fact, a relatively small share of ACOs demonstrated both favorable cost and quality trends."

5. BUNDLED PAYMENTS

A 2016 paper from Scott and Eminger titled "Bundled Payments: Value-Based Care Implications for Providers, Payers, and Patients" explores the 4 different payment models across 48 clinical bundles: "Bundle models include episode payment for services that range from acute care hospital-only episodes to episodes that include all acute, post acute, and physician's care services for 30, 60, or 90 days after discharge". In April 2016, it was reported that "more than 1500 entities were participating in the Based Care Implications program, including 385 acute care hospitals, 283 physician groups, and 681 skilled nursing facilities". The results of the bundled payments showed an "average reduction of $3286 per case for lower-extremity joint replacement episodes in 21 months, without a significant change in quality outcomes."

6. PATIENT-CENTERED MEDICAL HOMES

A study from February 2017 done by Hing et al. titled "Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices" shows that there is a larger percentage of primary care physicians in patient-centered medical home practices (68.8%) than non-PCMH practices (47.7%). This means that the home had "at least one physician assistant, nurse practitioner, or certified nurse midwife on staff". Additionally, the level of care quality was higher in PCMHs by almost 17% than in non-PCMH practices (86.8% compared to 70.2%).

7. ACCOUNTABLE CARE ORGANISATIONS

An article from August 2016 titled "Accountability across the Continuum: The Participation of Postacute Care Providers in Accountable Care Organizations" by Colla et al. provides an overview of accountable care organizations and the services they provide as well as the outcomes they achieve. In the article, the following results are mentioned: Outpatient rehabilitation (41%) and inpatient rehabilitation (35%) are identified as "most commonly included within accountable care organizations, while skilled nursing facilities are only included in a small proportion of ACOs (18%). Additionally, ACOs that include "post acute care are more likely to include other nontraditional services such as palliative/hospice care (72% vs. 7%), behavioral health (66% vs. 16%), and outpatient pharmacy (44% vs. 8%)".

CONCLUSION

Seven research articles have been listed regarding the most recent outcomes and evidence specific to alternative payment models for rehabilitation and therapy in home health care. For each paper, outcomes regarding home healthcare specific to rehab therapy and alternative payment models have been identified.
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