St. Joseph’s Home Care Collaborative Model to Build on Successes through Regulatory Flexibility

Syracuse-based St. Joseph’s Hospital Certified Home Health Agency (CHHA) is building on its role in achieving cost and quality targets for all of St. Joseph’s health system — thanks in large part to a relatively new state program allowing for collaboration and regulatory flexibility in home care’s work with other partners. 

The ‘Hospital-Home Care-Physician Collaboration’ Program was developed by HCA, passed by the Legislature, signed into law (in 2015), and implemented in late 2017.  It allows for voluntary collaborative programs: home care agencies, hospitals and physician practices working together to improve access to care, outcomes and cost-effectiveness. The law also includes a process for regulatory flexibility that further incentivizes collaborative care. This process has been pivotal to the St. Joseph’s model.

St. Joseph’s is employing the Collaboration law and regulatory waivers to maximize the success of its home care agency in working with other partners across the system to meet targets for quality and cost-reduction under state and federal value-based payment (VBP) programs. These VBP models require or incentivize risk-based or shared-savings contracts among providers and payors aimed at reducing utilization and improving outcomes.

St. Joseph’s Hospital Health Center has a series of risk-based VBP contracts in place to serve patients in several counties, but many of these counties, until recently, fell outside of the certified home health agency’s (CHHA’s) authorized service area, limiting its ability to partner with entities throughout the system in delivering better outcomes through value-based care. The Hospital-Home Care-Physician Collaboration program, however, allowed the home care agency to seek an expansion of its service area – to five additional counties – as the CHHA works to lead a multi-disciplinary Complex Care Coordination Model integrating and coordinating various teams that deliver care to 27,000 patients in a now expanded footprint for CHHA coverage.  

St. Joseph’s Heath Center hopes to expand the successes of its CHHA-led collaboration model to serve complex care cases beyond the counties where its CHHA was previously allowed to serve in fulfillment of value-based payment contracts that benefit patients throughout the St. Joseph’s Health System. In those counties already served by the CHHA model, patients have seen a 45% reduction in monthly inpatient admissions, a 27% reduction in monthly emergency department visits and a 70% reduction in hospital-based emergency psychiatric services.

Other providers are exploring similar paths of collaboration for which regulatory waivers are critical. This statute offers a promising opportunity to better align, synchronize and reduce the duplication of operational requirements for the fulfillment of state policy goals and enhanced patient care. HCA envisions countless examples where this kind of regulatory waiver incentive would best apply to the betterment of patient care and collaboration: for instance, allowing a home care agency to work with a physician office on assessments or flu vaccinations without triggering a patient’s formal admission to the home care agency nor all of the regulatory requirements that accompany a start-of-care admission.