The two facts participating in the fastest change with the health care system involves the aging of our population and the increased number of users with the Accountable Care Act creating ready access to a health care pay source. Individuals are living longer and we experience a higher need for health care service in older age. More people having access to health insurance means more people using the health care system.
Being at the initial stages of this change the health care system and the population will experience some instability (hospital readmissions) as community organizations adjust. The two most obvious components regarding this change can be explained as:
1. Available funds. Both public and private health insurance plans will declare a shortfall in money as risk reserve to guarantee health providers who perform covered benefits will be reimbursed in a timely manner.
2. Available staff. Health care providers will experience a consistent increase in the number of users challenging organizations to have adequate staff to safely meet the service need.
The current response is more defined constraints on payment and service. This reduces the outflow of the two resources listed above adequate funds, and adequate staff. This will look like:
1. The patient need is matched with the provider skill level. Public and private health insurance plans will not pay a Medicare certified Home Care Agency to send skilled staff to perform (ADL's) activities of daily living and (IADL's) instrumental activities of daily living for a need that can be safely met by a supportive (www.homecarepath.com) in home care agency.
2. Equal reimbursement across chosen settings of care. Public and private health insurance plans will reimburse providers at a level of defined (coding intensity) need. So even if the senior spent a night in the hospital under an observational outpatient claim category, the reimbursement could be challenged upon audit with the proper provision being home with supportive care agency and close contact with medical staff.
This will be a bit confusing for the staff participating in the health care delivery and the consumer receiving the health care service. It will appear different. Hospital readmissions are no longer acceptable. The health insurance payers are pushing the community to develop a network of health care provision that can better meet individual's needs. The one size fits all is transforming in to a how to best meet the need in the most fiscally responsible safe way. Individual's who make up the community are being asked to participate in a process that involves being good stewards of available resources (funds, staff) as the payers and providers adjust.
Home Care Path www.homecarepath.com and the Wisconsin PATH ALONG model deliver an advanced supportive care service. Helping seniors in the home, with clinic visits, at the hospital, nursing home and assisted living facility. Helping seniors downsize with a move in to an adult child's home. 2013 rates are 20.00 per hour. Simply call 608-432-4286 to schedule an interview. We can be there when you are working. We accept long term care insurance. Services can be tax deductible. Help with resources and the transition from private payment to public funded programming. Valuing home and human life. You are cordially invited to download your free PATH ALONG App, seniors are saying they would not go in to the hospital without their App.
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